title: Repair of complex pharyngocutaneous fistula using a staged temporoparietal fascial flap.
abstract: BACKGROUND
  PCF is the most common major complication after salvage total laryngectomy (TL), especially for previously irradiated patients with laryngeal or hypopharyngeal cancer.
  
  
  RESULTS
  A 65-year-old woman presented with recurrent bilateral supraglottic SCC requiring salvage TL 5.5years after initial T1N0M0 epiglottic SCC resection. Her post-operative course was complicated by PCF development one month post-operatively and surgical fistula closure was delayed for adjuvant chemoradiotherapy. The fistula persisted despite local wound therapy, several primary closures, pectoralis flap reconstruction with multiple revisions, and extensive hyperbaric oxygen treatments. Given her prior history, she underwent a staged right temporoparietal fascial flap reconstruction for persistent complex fistula, with second-stage flap takedown and complete inset of the TPFF skin island into the PCF.
  
  
  CONCLUSIONS
  This case demonstrates the utility of staged TPFF in complex PCF repair, with minimal morbidity, especially in a patient with prior irradiation and flap use that complicates tissue availability.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. Electronic address: nicholas_abt@meei.harvard.edu.
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Abt
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Srikanth
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Sidharth V
authors.initials: SV
authors.lastname: Puram
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D010608:Pharyngeal Diseases / Q000209:etiology / Q000601:surgery*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013524:Surgical Flaps
keywords: Fistula; Flap; Pharyngocutaneous fistula; TPFF; Temporoparietal fascial flap