title: Closure of post-laryngectomy pharyngocutaneous fistulae.
abstract: BACKGROUND
  Closure of salvage laryngectomy defects with vascularized tissue remains controversial.
  
  
  METHODS
  We evaluate outcomes in patients who required repair of a fistula after attempted primary closure of salvage laryngectomy defect and assess risk factors for persistent fistula. Between 2001 and 2010, 20 patients were treated for pharyngocutaneous fistulae after primary closure of a salvage laryngectomy. All patients required free flap repair for definitive fistula management.
  
  
  RESULTS
  Patients presented with fistulae from one to 18 months in duration; median time to closure was seven days. Radial forearm free flap was used in 86% of patients. With free flap alone 50% of patients achieved fistula closure. Additional procedures improved closure rate to 85%. Recipient vessels were used in the neck in 54.5%, compared to internal mammary vessels in 45.5%. Hypothyroidism was identified as a risk factor for persistent fistula (p = 0.01). Chronic steroid use (p = 0.08) did not reach significance as a risk factor for fistula closure. Gastroesophageal reflux disease was newly diagnosed or noted as a comorbidity in 14 patients (70%) in this study. It did not reach statistical significance as a risk factor in refistulization (p = 0.12). Complications included leak, carotid blowout, infection, free flap loss, and late refistulization. Overall flap failure in this study was 4.5%.
  
  
  CONCLUSIONS
  Delayed secondary repair of pharygocutaneous fistulas after salvage laryngectomy is associated with a higher complication rate and poor success rates compared to use of vascularized tissue at the time of salvage laryngectomy. Prolonged wound healing in these patients is associated with hypothyroidism.
authors: University of Washington, Puget Sound Veterans Administration Health System Department of Otolaryngology Head and Neck Surgery 1660 S Columbian Way, Mail Stop: S-112OTO, Seattle, WA, 98108, USA. isaac.bohannon@va.gov
authors: Isaac A
authors: IA
authors: Bohannon
authors: William R
authors: WR
authors: Carroll
authors: J Scott
authors: JS
authors: Magnuson
authors: Eben L
authors: EL
authors: Rosenthal
references: Radiother Oncol. 2004 Nov;73(2):119-31
references: 15542158
references: Arch Otolaryngol Head Neck Surg. 2003 Jan;129(1):44-9
references: 12525193
references: Otolaryngol Head Neck Surg. 2009 Aug;141(2):190-5
references: 19643250
references: Laryngoscope. 1996 Sep;106(9 Pt 1):1157-66
references: 8822723
references: Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):23-8
references: 12007937
references: Cancer. 1988 Feb 15;61(4):673-8
references: 3338032
references: Ann Otol Rhinol Laryngol Suppl. 1998 May;172:1-27
references: 9597955
references: Laryngoscope. 2007 May;117(5):781-4
references: 17473668
references: Otolaryngol Head Neck Surg. 2000 Sep;123(3):211-7
references: 10964293
references: Curr Opin Otolaryngol Head Neck Surg. 2009 Apr;17(2):111-5
references: 19373960
references: Arch Otolaryngol Head Neck Surg. 2007 Jun;133(6):526-32
references: 17576901
references: J Reconstr Microsurg. 2007 Aug;23(6):339-45
references: 17979066
references: Laryngoscope. 2009 Sep;119(9):1691-5
references: 19544379