Effect of Low-Pressure Drainage Suction on Pharyngocutaneous Fistula After Total Laryngectomy

Use of Cervical Fascia to Prevent Pharyngocutaneus Fistula After Total Laryngectomy

OBJECTIVE

This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates.

METHODS

We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer.

RESULTS

We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p = 0.471, p = 0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p > 0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p = 0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p = 0.015, r = -0.370).

CONCLUSION

The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost-effective.

LEVEL OF EVIDENCE

Level 3 Laryngoscope, 2024.

The efficacy of negative-pressure wound therapy for head and neck wounds: A systematic review and update

Despite the established benefits of negative-pressure wound therapy (NPWT) in various wound healing contexts, its application in head and neck surgical cases remains under-explored. This study aimed to systematically review its effectiveness, safety, and comparative efficacy. Thirty-one studies from a systematic literature search were identified and analyzed for wound healing response, overall success rate, improvements compared to conventional wound care, and variation in pressure settings, treatment lengths, and dressing change frequency. NPWT showed enhanced outcomes across diverse head and neck wounds, particularly complex post-reconstructive wounds and severe infections. Despite the predominantly case report/series evidence and lack of standardized NPWT protocols, its benefits over conventional care were clear. NPWT emerges as a promising approach for head and neck wound management, potentially improving patient outcomes and reducing complications. More randomized controlled trials are needed to solidify the evidence and standardize NPWT application protocols.

Current and Future Developments in Wound Healing

Poor wound healing on the face and neck can lead to significant morbidity and dissatisfaction in facial plastic surgery. With current advances in wound healing management and commercially available biologic and tissue-engineered products, there are several options available to optimize acute wound healing and treat delayed or chronic wounds. This article summarizes some of the key principals and recent developments in wound healing research in addition to potential future advancements in the field of soft tissue wound healing.

Radial forearm free flap and a freka-trelumina tube for management of a refractory pharyngocutaneous fistula: A case report

The management of pharyngocutaneous fistulas (PCFs) is challenging. A multidisciplinary treatment approach according to the clinical needs of a patient is essential for PCF management. Here, we describe the use of a double-layer closure technique involving a radial forearm free flap (RFFF) and a Freka-Trelumina nasojejunal tube in the reconstruction of a refractory PCF.