Treatment of Cervical Fistulae after Microsurgical Reconstruction Following Radical Ablation of Head and Neck Cancers
Authors: Masaki Fujioka
Abstract: Background Cervical fistulae caused by unsuccessful wound healing after microsurgical reconstruction are sometimes seen in patients who have undergone radical ablation of head and neck malignancies. They can cause long-term distress for the patient and decrease their quality of life. Furthermore, treatment of fistulae is challenging because these patients have often undergone radiotherapy. Methods We reviewed the records of 83 patients with head and neck cancer who required radical resection and microsurgical reconstruction in our unit from 2004 through 2007. Among these patients, 11 developed cervical fistulae postoperatively. We investigated the associations between radiotherapy, chemotherapy, tumor size, lymph node metastasis, and type of flaps and the development of postoperative fistulae. Results All 11 patients who developed cervical fistulae had undergone radiotherapy, which was identified as the most important risk factor for postoperative cervical fistulae. All the fistulae were successfully treated with a pectoralis major musculocutaneous flap. Conclusions Cervical fistulae that occurred after radiotherapy and microsurgical reconstruction do not heal spontaneously despite aggressive medical wound management. Skin grafts and local cutaneous flaps harvested from within the radiation field are unreliable and rarely provide adequate and stable coverage. Salvage surgery using a musculocutaneous flap is recommended to facilitate healing of these complex wound.