Closing of large pharyngostomes with free flaps and proposal of a new classification
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HEAD AND NECK
Closing of large pharyngostomes with free flaps and proposal of a new classification J. L. Llorente1 · P. Sánchez1 · F. López1 · D. Camporro2 · A. Fueyo2 · R. Charlone1 · J. P. Rodrigo1 · C. Álvarez‑Marcos1 Received: 17 February 2020 / Accepted: 24 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Large pharyngocutaneous fistulas or pharyngostomes are difficult complications to solve, which generate high morbidity and mortality, a poor quality of life and an increase in health costs. Its management must be comprehensive according to general, local and regional factors. We review our experience in treating these pharyngostomes with free flaps. Methods Retrospective study analyzing the results of the reconstruction of 50 patients using free flaps during the period 1991–2019. We exclude patients who required free-flap reconstruction due to primary tumor or those who resolved in other ways. The different types of reconstruction were classified into three types. Results The 86% (43) were men, and the mean age was 57 years (25–76). In 48% (24/50) the flaps performed were anterolateral thigh (ALT), in 24% (12/50) forearm, in 22% (11/50) parascapular, in 4% (2/50) jejunum and in 2% (1/50) ulnar. A salivary by-pass was placed in 74% (37/50) of the cases. Four cases (8%) presented flap necrosis and two patients died due to treatment. In 86% (43/50) there was some type of complication and 34% (17/50) required surgical revision. 94% (45/48) were able to reintroduce oral feeding. Conclusion According to our experience, we proposed a regardless size classification: type 1 when only a mucous closure (pharynx) are required (6%), type 2 exclusively skin for cutaneous coverage (10%) and mixed type 3 (mucous and skin) (84%). The treatment of large pharyngostomes with free flaps, despite its complexity, is in our experience the best option for its management. Keywords Pharyngocutaneous fistula · Pharyngostomes · Free flaps in head and neck · Pharyngolaryngectomy · Head and neck reconstruction
Introduction Pharyngocutaneous fistulas or pharyngostomes are relatively frequent complications (15–30%) after pharynx and/or larynx surgery [1]. These complications occur especially in patients with advanced-stage tumors and poor general condition, mostly smokers/drinkers, with accompanying chronic lung, heart, vascular or liver diseases, and advanced TNM, among others [2]. In addition, there are other risk factors that favor the formation of fistulas in the postoperative period (local infection, * P. Sánchez [email protected] 1
Department of ENT, Hospital Universitario Central de Asturias, C/Avenida de Roma s/n, 33011 Oviedo, Spain
Department of Plastic Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
2
anemia, etc.). The previous radiotherapy has been determined as an important factor triggered by the fistula in the postoperative period when leaving devitalized cervical tissues [2, 3]. Pharyngocutaneous fistulas significantly increase patient morbid
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