title: Massive pharyngocutaneous fistulae: salvage with two-layer flap closure.
abstract: Massive pharyngocutaneous fistulae may be arbitrarily defined as those involving two-thirds or more of the circumference of the pharyngeal wall. Three such patients are presented, all after failed radiotherapy and surgery. The principles of management consist of salivary diversion, complete debridement, nutritional support, prophylactic antibiotics, and two-layer, well-vascularized overlapping closure. We currently recommend a radial forearm flap used in conjunction with a pectoralis muscle (or musculocutaneous) flap for rapid rehabilitation of these patients, particularly in the presence of obesity or an irradiated bed.
authors.affiliation: Division of Plastic Surgery, Toronto Hospital, Ontario, Canada.
authors.forename: B G
authors.initials: BG
authors.lastname: Peat
authors.forename: J B
authors.initials: JB
authors.lastname: Boyd
authors.forename: P J
authors.initials: PJ
authors.lastname: Gullane
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010608:Pharyngeal Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D015607:Stents; D013524:Surgical Flaps / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000601:surgery