Abstract
Background: Pharyngocutaneous fistula is a major complication that occurs after salvage surgery following radiotherapy for laryngeal cancer. It is characterized by extensive neck skin defects and pharyngeal defects, necessitating biplane reconstruction for surgical treatment.
Methods: We retrospectively examined the surgical procedure and postoperative course of pharyngocutaneous fistula in patients with extensive neck skin defects who were operated on in our department.
Results: A pectoralis major myocutaneous flap was employed for reconstruction in five cases, while the free anterolateral thigh flap was used in one. In two cases where the pectoralis major myocutaneous flap was used, reconstruction was done with two skin paddles; in one case, a skin paddle and a muscle flap with a skin graft were used for reconstruction. The patient, for whom an anterolateral thigh flap was used, underwent reconstruction using two skin paddles, each containing one perforator artery. A pectoralis major myocutaneous flap with a skin graft and a free anterolateral thigh flap yielded favorable outcomes.
Conclusion: A free anterolateral thigh flap is recommended if the neck has anastomotic vessels in unilateral neck dissection. Conversely, if the use of free flaps is avoided, a pectoralis major flap with a skin paddle on the pharyngeal side and a skin graft on the muscle flap on the skin side is recommended.
Pre-operative, intra-operative, and post-operative photographs of Case 6.
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(a) Preoperative finding. The pharyngeal fistula extended into the tracheal foramen. Extensive inflammation of the neck skin on the cranial side. (b) Anterolateral thigh flap design: Two skin paddles based on two myocutaneous branches of the descending branch of the lateral circumflex femoral artery. The white arrow indicates the larger skin paddle based on the cranial perforator, and the yellow arrow indicates the smaller skin paddle based on the caudal perforator. (c) A larger skin paddle was used for the reconstruction of the neck skin defect (white arrow), and a smaller skin paddle was sutured to the pharyngeal defect as a patch graft (yellow arrow). The undivided fascia lata. (d) Appearance one year after the operation.
