A fibrin seal closure technique for prolonged postoperative pharyngocutaneous fistula

Abstract

A total pharyngo-laryngectomy with pharyngeal reconstruction by free jejunum transfer was performed due to recurrence of hypopharyngeal cancer after concurrent chemoradiotherapy (CCRT) in a 77-year-old male patient. Postoperatively, a pharyngocutaneous fistula developed at the site of jejunum-esophageal anastomosis. Application of trafermin (basic fibroblast growth factor: bFGF) spray, patch-graft reconstruction using a pectoral major muscular flap and covering by absorbable polyglycolic acid (PGA) felt were sequentially performed as closure of the fistula approached, resulting in a smaller residual fistula. The fistula was totally closed by fibrin seal closure on the 140^th postoperative day.
Postoperative pharyngocutaneous fistula is a major complication of surgery for head and neck malignancies. In salvage surgery after radiotherapy or CCRT, this complication often bothers the surgeon because it usually requires a very long time to heal. Sealing the fistula by fibrin glue may be an effective procedure for prolonged postoperative pharyngocutaneous fistula.