Closure of large pharyngo-oesophageal fistulas with free flap transfer after resections for cancer.
Postoperative salivary fistulas still remain a serious and potentially lethal problem in head and neck reconstruction particularly if the fistula is large and involving one half or more of the circumference of the pharyngo-oesophagus. Pedicled flaps have traditionally been the flaps of choice for closure of these fistulas, but the results are often disappointing. During the period 1982 to 1995, we have used either a radial forearm free flap or a jejunal free flap to close large and complex pharyngo-oesophageal fistulas after resection for cancer in 15 patients. Although two patients developed major fistulas that required additional operations for closure, successful closure was achieved in all but one case: the success rate was therefore 14/15 (93%). We consider that jejunal flaps are suitable for circumferential pharyngo-oesophageal reconstruction and forearm flaps for non-circumferential defects.
Nakatsuka
T
T
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tokyo, Japan.
Harii
K
K
Ebihara
S
S
Saikawa
M
M
Kato
H
H
Tachimori
Y
Y
Ueda
K
K
D000368:Aged; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D008297:Male; D010608:Pharyngeal Diseases / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D013524:Surgical Flaps