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Park J, Chang C, Kwon D. Use of fibrin adhesive for preventing pharyngocutaneous fistula in total laryngectomy. Am J Otolaryngol 2020; 41:102674. [PMID: 32836041 DOI: 10.1016/j.amjoto.2020.102674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimizing pharyngocutaneous fistula after total laryngectomy is a perpetual focus for head and neck surgeons. Multiple intrinsic and extrinsic factors have been implicated in the wound healing process. Activated fibrin glue uniquely promotes healing as a tissue adhesive as well as a biochemical growth factor. METHODS We present a pilot case series of total laryngectomy with simple pharyngeal closure with a single surgeon. Fibrin tissue adhesive was incorporated in all patients along with standardized pre-operative, operative, and post-operative care. Outcomes measured included pharyngocutaneous fistula rate, perioperative complications, and other wound complications as well as long term swallowing function and voice rehab outcomes. We also present a review of the literature for the theoretical basis of using fibrin glue as well as other similar applications. RESULTS Fibrin tissue adhesive was successfully used in 18 consecutive patients undergoing total laryngectomy and pharyngoplasty. Despite the presence of a variety of wound healing risk factors including prior radiation and tobacco use, there were no pharyngocutaneous fistulas or other significant wound problems. No locoregional or free tissue overlay flap was done. CONCLUSION Fibrin tissue glue is a readily available, easily applied, and cost-effective adjunct that may reduce pharyngocutaneous fistula.
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Roof SA, Perez ER, Villavisanis DF, Khan MN, Ferrandino RM, Chouake RJ, Pacheco CW, Yao M, Teng MS, Genden EM, Miles BA. 2-Octyl cyanoacrylate to prevent salivary fistula formation following oral cavity microvascular reconstruction: A prospective trial. Am J Otolaryngol 2020; 41:102552. [PMID: 32505990 DOI: 10.1016/j.amjoto.2020.102552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Salivary fistulas remain a significant problem in patients undergoing major head and neck reconstructive surgery. Surgical sealants have become increasingly used in cutaneous and non-cutaneous wound closure, providing a barrier to fluids/gases and promoting healing. The purpose of this study was to determine the efficacy of a common surgical sealant, 2-Octyl Cyanoacrylate (2-OCA, Dermabond®), in the prevention of salivary fistulas following free flap reconstruction of the oral cavity. METHODS In this non-randomized, single arm prospective trial, patients undergoing free flap reconstruction of gravity-dependent oral cavity defects were recruited. Application of 2-OCA was performed along flap inset suture lines at the time of surgery. Prospectively collected trial data were propensity score matched to a control cohort to compare outcomes. Data collected include demographics, medical co-morbidities, previous treatments, primary tumor site, and subsites reconstructed. The primary outcome measure was rate of salivary fistula formation. Secondary outcomes were time to development of leak and percentage of patients tolerating oral feeding at one month post-operatively. RESULTS In the 46 propensity score matched pairs, eight (17.4%) out of 46 patients in the 2-OCA prospective cohort and seven (15.2%) out of 46 patients in the control cohort developed postoperative salivary fistulas within the one-month study interval (p = 1.00). The average time to postoperative leak in the 2-OCA group was 12.5 days versus 7.1 days in the control cohort (p = 0.10). In the 2-OCA group, 30 (65.2%) patients were tolerating regular diet at one month post-operatively compared to 33 (71.7%) in the control cohort (p = 0.65). CONCLUSION Salivary fistula rates after application of a 2-OCA surgical sealant were not improved compared to a control cohort in this single institutional trial. There are several surgical sealants available, each with varying elasticity and adhesiveness. Future studies are needed to identify surgical sealants that are able to provide sufficient strength and adhesion to seal closures and combat corrosive saliva, but elastic enough to handle motion related tension during swallowing and post-operative movements in the head and neck.
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Affiliation(s)
- Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
| | - Enrique R Perez
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | | | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Rocco M Ferrandino
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Robert J Chouake
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caitlin W Pacheco
- Department of Otolaryngology Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, CA, USA
| | - Mike Yao
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Marita S Teng
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Eric M Genden
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
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Molteni G, Sacchetto A, Sacchetto L, Marchioni D. Optimal Management of Post-Laryngectomy Pharyngo-Cutaneous Fistula . OPEN ACCESS SURGERY 2020. [DOI: 10.2147/oas.s198038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Stephenson KA, Pandey S, Lubbe DE, Fagan JJ. Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy. Head Neck 2018; 40:2606-2611. [DOI: 10.1002/hed.25334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 01/13/2018] [Accepted: 04/19/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Sarita Pandey
- Division of OtorhinolaryngologyFrere Hospital East London South Africa
| | - Darlene E. Lubbe
- Division of Otorhinolaryngology, Faculty of Health SciencesUniversity of Cape Town Cape Town South Africa
| | - Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health SciencesUniversity of Cape Town Cape Town South Africa
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Demir B, Sarı M, Binnetoglu A, Yumusakhuylu AC, Filinte D, Tekin İÖ, Bağlam T, Batman AÇ. Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model. Auris Nasus Larynx 2018; 45:301-305. [DOI: 10.1016/j.anl.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
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ZHANG XIANGMIN, LIU FOLIN, LAN XIAOLIN, LUO KEQING, XIAO FUFU, LI SHAOJIN. Continuous negative pressure-flush through a dual tube for the treatment of a complicated pharyngeal fistula: A case report. Oncol Lett 2016; 11:1815-1818. [PMID: 26998082 PMCID: PMC4774409 DOI: 10.3892/ol.2016.4152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 12/10/2015] [Indexed: 11/06/2022] Open
Abstract
The treatment of pharyngeal fistulas is complicated. It is more difficult to deal with pharyngeal fistula following surgical treatment for hypopharynx carcinoma, particularly in cases of pectoralis major muscle flap repair. The present study describes the case of a 56-year-old man who presented with a highly-differentiated pharyngeal squamous cell carcinoma located at the right side of the hypopharynx. The patient underwent a total laryngectomy and a right functional carotid dissection and tracheostomy; this was followed by post-operative radiotherapy. A pharyngeal fistula subsequently developed, but an attempt to repair this with a pectoralis major muscle flap failed. The complicated pharyngeal fistula was treated via continuous negative pressure-flush through a dual tube, without the requirement for incision, daily dressing or antibiotics. The favorable patient outcome represented a positive result, which was also able to reduce the psychological burden of the patient and improve their quality of life.
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Affiliation(s)
- XIANGMIN ZHANG
- Department of Head and Neck Surgery, Ganzhou Tumor Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - FOLIN LIU
- Institute of Cancer Research, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi 341000, P.R. China
| | - XIAOLIN LAN
- Department of Head and Neck Surgery, Ganzhou Tumor Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - KEQING LUO
- Department of Head and Neck Surgery, Ganzhou Tumor Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - FUFU XIAO
- Department of Head and Neck Surgery, Ganzhou Tumor Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - SHAOJIN LI
- Institute of Cancer Research, Ganzhou Institute of Cancer Research, Ganzhou, Jiangxi 341000, P.R. China
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Effectiveness of Recombinant Human Growth Hormone for Pharyngocutaneous Fistula Closure. Clin Exp Otorhinolaryngol 2015; 8:390-5. [PMID: 26622960 PMCID: PMC4661257 DOI: 10.3342/ceo.2015.8.4.390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/17/2014] [Accepted: 08/05/2014] [Indexed: 11/08/2022] Open
Abstract
Objectives In laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery. We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase in amino acid uptake and protein synthesis for wound healing, an increase in mitogenesis, and enhancement of collagen formation by recombinant human growth hormone. Methods This study was experimental animal study. Forty Sprague-Dawley rats were separated into two groups, and pharyngoesophagotomy was performed. The pharyngoesophagotomy was sutured with vicryl in both groups. Rats in group 1 (control group) received no treatment, while those in group 2 were administered a subcutaneous injection of recombinant human growth hormone daily. On day 14, the pharynx, larynx, and upper oesophagus were excised and examined microscopically. Results Pharyngocutaneous fistula exhibited better closure macroscopically in the recombinant human growth hormone group. There was a significant difference in collagen formation and epithelisation in the recombinant human growth hormone group compared to the control group. Conclusion This study is believed to be the first in which the effect of recombinant human growth hormone on pharyngocutaneous fistula closure was evaluated, and the findings suggest the potential of use of growth hormone for treatment of pharyngocutaneous fistula.
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Al-Qahtani K. Initial experience with hemostatic fibrin glue as adjuvant during drainless parotidectomy. Saudi Dent J 2010; 23:67-71. [PMID: 23960501 DOI: 10.1016/j.sdentj.2010.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/05/2010] [Accepted: 11/15/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the use of Hemostatic Fibrin Glue in parotidectomy without the use of surgical drains. STUDY DESIGN Prospective cohort study of 10 patients undergoing parotidectomy. Surgery as a one day admission without the use of surgical drains was planned. The complication and duration of the hospital stay were obtained. METHODS Parotidectomy was undertaken by one surgeon. Prior to wound closure, the skin flap and wound bed were approximated using Tisseel tissue sealant. Data regarding the incidence of any complication and the duration of the hospital stay were obtained. Patients were followed to assess surgical outcome and document any complications. The mean follow-up period was 8 months (range 4-12 months). RESULTS There were no major surgical complications. Two patients had facial nerve weakness due to adherence of the tumour in the facial nerve, in there was which complete recovery after few months. All patients were discharged the next day. None of the patients felt that the discharge had been premature. CONCLUSIONS Parotidectomy can be undertaken safely without the need for surgical drains, therefore, allowing the patients to leave the hospital on the first postoperative day.
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Affiliation(s)
- Khalid Al-Qahtani
- King Saud University, ORL & Head and Neck Surgery, King Abdulaziz Street, Riydah 0533301118, Saudi Arabia
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de Santana ME, Sawada NO. Pharyngocutaneous fistulae after total laryngectomy: a systematic review. Rev Lat Am Enfermagem 2008; 16:772-8. [PMID: 18833462 DOI: 10.1590/s0104-11692008000400019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 05/19/2008] [Indexed: 11/22/2022] Open
Abstract
Nursing care to patients after total laryngectomy should be based on scientific knowledge. Evidence-based practice is a type of approach that stimulates the use of research results in clinical practice. This study presents a systematic review that aimed to identify the main treatments for pharyngocutaneous fistulae after total laryngectomy. Articles were selected from five databases: Pubmed, Cinahl, Biomednet Research Tools, Cochrane Library and Lilacs. The review sample consisted of 37 articles. After analyzing the articles included in the review, results showed that conservative treatment is commonly used for pharyngocutaneous fistulae, recommending intensive hygiene and wound treatment. The use of research results in clinical practice will grant greater consistency to nurses' actions in care for patients with pharyngocutaneous fistulae.
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Magdy EA. Surgical closure of postlaryngectomy pharyngocutaneous fistula: a defect based approach. Eur Arch Otorhinolaryngol 2007; 265:97-104. [PMID: 17687561 DOI: 10.1007/s00405-007-0414-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 07/25/2007] [Indexed: 10/23/2022]
Abstract
Surgical repair of postlaryngectomy pharyngocutaneous fistula (PCF) can be challenging. Although several studies describe separate reconstruction methods, only few address the variability in defect characteristics and hence flap selection. The current clinical study presents a retrospective review of 19 patients who underwent surgical repair of persistent PCFs, over a 4-year period in a tertiary referral institute by a single primary surgeon. All but one patient were men with a mean age of 61 +/- 10 years. Nine patients had previous unsuccessful attempts for surgical closure. Previous neck irradiation was the most common comorbid condition encountered (52.6%), followed by low hemoglobin level (47.4%), hepatic disease (36.8%) and diabetes mellitus (31.6%). According to defect characteristics, six patients received a local cervical skin procedure, ten patients had reconstructions using the pectoralis major musculocutaneous flap and three patients required a radial forearm free flap repair. All PCFs were eventually successfully closed with no major complications. Patients were followed-up for an average of 19.7 months (range, 5-38 months). Acceptable oral swallowing results were achieved in all but one patient. In conclusion, successful results are achievable in difficult persistent PCF cases with a defect based reconstruction approach kept in mind.
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Affiliation(s)
- Emad A Magdy
- Department of Otorhinolaryngology-Head and Neck Surgery, Alexandria University Medical School, Alexandria, Egypt.
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Sevilla García MA, Suárez Fente V, Rodrigo Tapia JP, Llorente Pendás JL. [Montgomery salivary bypass tube: a simple solution for pharyngocutaneous fistulas]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:467-70. [PMID: 17228647 DOI: 10.1016/s0001-6519(06)78750-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The pharyngocutaneous fistulas (PCF) are among the complications surgeons and nursing personnel fear the most due to their complexity to prevent and/or cure them. Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the PCF following laryngectomy. The aim of our study was to describe our experience with salivary bypass in the treatment of the PCF. METHODS This was a retrospective analysis of pharyngocutaneous fistulas in 21 patients in whom total laryngectomy was performed for squamous cell carcinoma of the larynx or hypopharynx (January 1999-December 2005). We determinate the overall efficacy of the Montgomery salivary bypass tube in the treatment of the PCF. RESULTS A pharyngocutaneous fistula developed within a mean time of 7 days from surgery (from 2nd to 20th day). Montgomery salivary bypass tube was the therapeutic option in all these PCF.12 patients required local anesthesia to introduce the tube and in 9 patients the insertion method was with general anesthesia with direct vision of the hypopharynx. The mean healing time was 26 days, except in one case. This PCF achieved spontaneous closure with local wound care after the bypass was removed. CONCLUSIONS The observed results corroborated the relevance of Montgomery salivary bypass tube as an important therapeutic option in the treatment of the PCF. There was no need of surgical treatment.
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Affiliation(s)
- M A Sevilla García
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias.
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Esteban F, Delgado-Rodríguez M, Mochón A, Solano J, Soldado L, Solanellas J. Estudio de la estancia tras laringuectomía total: análisis retrospectivo multivariable de 442 laringuectomías totales. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 57:176-82. [PMID: 16686227 DOI: 10.1016/s0001-6519(06)78687-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Pharyngocutaneous salivary fistula is the most common complication following total laryngectomy. Fistulae can lead to prolonged hospitalization and increased patient morbidity. OBJECTIVE To investigate those factors related to increased length of stay following total laryngectomy. To further analyze those related with fistula after surgery. MATERIAL AND METHODS Retrospective study on 442 patients who undenwent total laryngectomy. Study of the covariance (ANCOVA). Uni and multivariate analysis of factors related to salivary fistula. RESULTS We identified alcohol intake, year of surgery and salivaly fistula as factors independently related with increased length of stay at the hospital. Factors independently related with fistula were alcohol intake, tumors affecting tongue base or pyriform sinus, surgeon, fever in the inmediate postoperative period, or wound closure using fibrin blue (negative association with the later). CONCLUSIONS Pharyngocutaneous salivary fistula increases three times hospital length of stay in patients undergoing total laryngectomy. We identified the surgeon as the factor more closely related with this complication, and we suggest the need to create well-defined head and neck cancer groups to deal with these surgical procedures.
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Affiliation(s)
- F Esteban
- Servicio de Otorrinolaringología de los Hospitales Universitarios Virgen del Rocío de Sevilla.
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