Use of a collagen patch for management of pharyngocutaneous fistula after hypopharyngeal reconstruction.
Pharyngocutaneous fistula is one of the fatal complications occurring after head and neck reconstruction with neck node dissection. Even minor salivary leakage from the fistula could cause serious infection and threaten the viability of the transferred flap or even lead to the rupture of jugular vein. In such cases, proper management is difficult, and the chances for recurrence rise. We used a collagen patch (TachoComb) for fistula prevention and treatment. TachoComb, a collagen patch integrated with activated thrombin and fibrinogen, was used to prevent postoperative fistula formation in the initial reconstruction by applying them on sites with a high risk of salivary leakage. The patch was applied to 16 patients who had hypopharyngeal reconstruction, and the results were evaluated and compared with patients who had reconstruction without a collagen patch. A fistula occurred in 1 (6%) of 16 patients who received the collagen patch, whereas it occurred in 6 (14%) of 43 patients who underwent reconstruction without the collagen patch. In addition, the collagen patch was also used to treat postoperative fistula in 2 patients, and the results were successful after a single revision. Our results suggest that the collagen patch can be effective in the prevention and treatment of postoperative fistula after head and neck reconstruction, especially pharynx and cervical esophagus.
Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Seoul, Republic of Korea.
Dong Won
DW
Lee
Seum
S
Chung
Won Jai
WJ
Lee
Eun Chang
EC
Choi
Dae Hyun
DH
Lew
D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D003094:Collagen / Q000008:administration & dosage / Q000627:therapeutic use*; D017577:Cutaneous Fistula / Q000517:prevention & control*; D004338:Drug Combinations; D005340:Fibrinogen / Q000008:administration & dosage / Q000627:therapeutic use*; D058752:Free Tissue Flaps; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D007013:Hypopharynx / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D037981:Neck Dissection; D010608:Pharyngeal Diseases / Q000517:prevention & control*; D010611:Pharyngectomy; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012463:Saliva; D013524:Surgical Flaps; D013536:Suture Techniques; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D014014:Tissue Adhesives / Q000008:administration & dosage / Q000627:therapeutic use*
D004338:Drug Combinations; D006490:Hemostatics; D014014:Tissue Adhesives; C093991:tachocomb; D005340:Fibrinogen; D003094:Collagen; D007611:Aprotinin; D013917:Thrombin