title: New double-layer design for 1-stage repair of orocutaneous and pharyngocutaneous fistulae in patients with postoperative irradiated head and neck cancer.
abstract: The development of a postoperative orocutaneous fistula (OCF) or pharyngocutaneous fistula (PCF) in the irradiated tissues of patients with head and neck cancer represents a high burden of morbidity for the patient. With high postoperative recurrence rates, these fistulae result in a reconstructive challenge for the plastic surgeon. In this study, we propose a new double-layer design to successfully repair these fistulae in a 1-stage reconstruction.
  
  
  
  Twelve patients with an average age of 56 years (range, 45-67 years) were operated on between January 2006 and December 2012 using this double-layer single-stage technique. All patients had received postoperative radiotherapy after their initial reconstruction. A circumferential turnover flap was designed and raised from the skin surrounding the fistula to recreate inner lining using a tension-free, water-tight repair. No debridement of the fistula itself was performed. The second-layer of the reconstruction, which represents the outer lining, was achieved with either a local or a free flap.
  
  
  
  Fistula size ranged from 0.8 × 0.5 cm to 3 × 3.2 cm with a mean size of 2 cm(2) . The outer lining was achieved using a free flap in 5 cases and a local flap in 7 cases. All the flaps survived completely with no cases of postoperative infection, however, 1 case was complicated by mandibular plate exposure necessitating its removal. No major complication or recurrence has yet been encountered in any of our patients with a mean follow-up of 28 months (range, 12-78 months).
  
  
  
  This 1-stage double-layer design can provide a reliable and relatively straightforward means of repairing OCF and PCF in the irradiated tissues of patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E353-E359, 2016.
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Parviz L
authors.initials: PL
authors.lastname: Sadigh
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Cheng-Jung
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Department of Management, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Wen-Jui
authors.initials: WJ
authors.lastname: Feng
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng
mesh_terms: D000368:Aged; D017577:Cutaneous Fistula / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010608:Pharyngeal Diseases / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D013524:Surgical Flaps / Q000637:transplantation*
keywords: double-layer repair; head and neck cancer; irradiated tissue; orocutaneous fistula; pharyngocutaneous fistula