Pharyngocutaneous fistula repair after radiotherapy and salvage total laryngectomy

Managing a pharyngocutaneous fistula in patients who have had total laryngectomy and radiotherapy is difficult. The purpose of this study was to review our experience using anterolateral thigh flaps to repair these defects. Between May 2002 and May 2006, pharyngocutaneous fistulas were repaired in nine consecutive patients. The first five patients had been managed conservatively for several months before repair was performed. The recent four patients were repaired within 1 month of fistula formation. Eight patients had frozen necks, which required neck resurfacing. Risky carotid artery exposure was avoided by using the transverse cervical vessels as recipient vessels. Pharyngocutaneous fistulas occurred between 8 and 30 days after a total laryngectomy. Early repair was much easier than late repair due to severe scaring and stricture associated with long-standing fistulas. All flaps survived. The mean hospitalization was 7 days. No recurrent fistulas or strictures developed after 11 to 48 months of follow-up. All patients achieved 100% oral alimentation. Five of the six patients eligible for tracheoesophageal puncture achieved fluent speech. Using the multi-island anterolateral thigh flap and transverse cervical vessels in pharyngeal reconstruction provides quick recoveries and excellent functional outcomes. Early repair is strongly recommended once a postlaryngectomy pharyngocutaneous fistula is identified.