Critical Oropharyngocutaneous Fistulas after Microsurgical Head and Neck Reconstruction: Indications for Management Using the "Tissue-Plug" Technique

Christopher Salgado, Samir Mardini, Hung Chi Chen, Samuel Chen

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Despite advances in head and neck reconstruction with free-tissue transfer techniques, oropharyngocutaneous fistulas continue to present challenging and potentially lethal complications. The authors present a system for prioritizing these fistulas and the surgical management of nine patients in whom critical fistulas developed after microsurgical head and neck reconstruction. The indications for aggressive management of these fistulas were primarily dependent on their location. Three peristomal and six midneck fistulas were considered critical because of the risk of aspiration pneumonia and carotid artery blowout, respectively. Fistulas located in the submental and/or submandibular region were considered noncritical and were managed conservatively. Using the concept of a "tissue plug" for fistula repair, a dermal component (i.e., a deltopectoral or pectoralis major pedicled flap) is guided through the fistula, and with external traction the tissue "plugs" the tract. No sutures are placed directly in the surrounding friable tissue. There were no partial or total flap losses. There were two fistula recurrences in patients who had received postoperative radiation therapy. One of these recurrences was due to tumor recurrence within the previous fistula and was managed with palliative measures. The other fistula recurrence was closed with a local-flap procedure on an outpatient basis. All patients resumed oral feeding, except for the patient in whom tumor recurrence was suspected. This tissue-plug technique can be used in the management of critical peristomal and/or midneck oropharyngocutaneous fistulas not only to obliterate the tract but also to augment volume and vascularity in already damaged, ischemic, and deficient tissue.

Original languageEnglish
Pages (from-to)957-963
Number of pages7
JournalPlastic and Reconstructive Surgery
Volume112
Issue number4
DOIs
StatePublished - Sep 15 2003
Externally publishedYes

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Fistula
Neck
Head
Recurrence
Cutaneous Fistula
Aspiration Pneumonia
Surgical Flaps
Traction
Carotid Arteries
Sutures
Neoplasms
Outpatients
Radiotherapy
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

Critical Oropharyngocutaneous Fistulas after Microsurgical Head and Neck Reconstruction : Indications for Management Using the "Tissue-Plug" Technique. / Salgado, Christopher; Mardini, Samir; Chen, Hung Chi; Chen, Samuel.

In: Plastic and Reconstructive Surgery, Vol. 112, No. 4, 15.09.2003, p. 957-963.

Research output: Contribution to journalArticle

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