Reconstruction of the Pharyngocutaneous Fistula After Laryngectomy with Full-Thickness Skin Graft and Pectoralis Major Myocutaneous Flap.

Abstract

Pharyngocutaneous fistula is the most common complication after total laryngectomy and increases morbidity by prolonging hospital stay. Factors such as history of radiotherapy, tumor size, anemia and diabetes are effective in its development. Treatment options include conservative and surgical methods. A 72-year-old man underwent total laryngectomy and right neck dissection for advanced laryngeal cancer. Pharyngocutaneous fistula developed on postoperative day 5. Initially, local intervention and nasogastric feeding were performed, but the defect progressed. On postoperative day 30, repair was performed with a pectoralis major myocutaneous flap. The fistula recurred because the patient did not follow the recommendations. Subsequently, a successful reconstruction was achieved with supraclavicular full-thickness skin graft and deltopectoral flap. Pharyngocutaneous fistula is a common and difficult to manage complication after total laryngectomy. Early detection and appropriate treatment approach reduces morbidity. For reconstruction of large defects, myocutaneous flaps and double-layer repair with full- thickness skin grafting are effective. In this case, the fistula was completely healed with a successful reconstruction and the patient was able to switch to oral feeding.