The occurrence of pharyngocutaneous fistula after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery. The cause and management guidelines are still controversial. Contributing risk factors of impaired wound healing should be recognized in preoperative planning. Perioperative technical issues and preventive postoperative care play a major role in the prevention of fistulae, limiting the severity of the fistula and minimizing secondary complications. Surgical salvage of cancers treated with organ preservation approaches is associated with higher rates of postoperative complications, particularly in cases in which mucosal membranes are transgressed and surgically closed. Patients who require surgical repair are best treated by the use of regional myocutaneous flaps or free tissue transfers. This subset of patients is likely best treated in regional centers of excellence with well developed multidisciplinary programs for ablative and reconstructive head and neck surgery.
Department of Otolaryngology and Department of Surgical Oncology, Wharton Head and Neck Center, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
Correspondence to Patrick J. Gullane, MB, FRCSC, FACS, Toronto General Hospital, Eaton North 7-242, 200 Elizabeth Street, Toronto, ON, M5G 2C4 Canada; e-mail: firstname.lastname@example.org