ABSTRACT
Managing a pharyngocutaneous fistula in patients who have had total laryngectomy and
radiotherapy is difficult. The purpose of this study was to review our experience
using anterolateral thigh flaps to repair these defects. Between May 2002 and May
2006, pharyngocutaneous fistulas were repaired in nine consecutive patients. The first
five patients had been managed conservatively for several months before repair was
performed. The recent four patients were repaired within 1 month of fistula formation.
Eight patients had frozen necks, which required neck resurfacing. Risky carotid artery
exposure was avoided by using the transverse cervical vessels as recipient vessels.
Pharyngocutaneous fistulas occurred between 8 and 30 days after a total laryngectomy.
Early repair was much easier than late repair due to severe scaring and stricture
associated with long-standing fistulas. All flaps survived. The mean hospitalization
was 7 days. No recurrent fistulas or strictures developed after 11 to 48 months of
follow-up. All patients achieved 100% oral alimentation. Five of the six patients
eligible for tracheoesophageal puncture achieved fluent speech. Using the multi-island
anterolateral thigh flap and transverse cervical vessels in pharyngeal reconstruction
provides quick recoveries and excellent functional outcomes. Early repair is strongly
recommended once a postlaryngectomy pharyngocutaneous fistula is identified.
KEYWORDS
Pharyngocutaneous fistula - anterolateral thigh flap - perforator flap - tracheostoma
reconstruction - head and neck reconstruction
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Peirong YuM.D.
Department of Plastic Surgery, Unit 443, The University of Texas M.D. Anderson Cancer
Center
1515 Holcombe Boulevard, Houston, TX 77030
