Three-stage pectoral fasciocutaneous flap as an alternative to pharyngocutaneous fistula closure after salvage laryngectomy

Abstract

Salivary fistulas are among the most feared complications after head and neck oncological surgeries. Its presence increases hospital length of stay and patient costs and may be associated with severe complications such as carotid rupture. Although there are no clinical guidelines for managing salivary fistulas after laryngectomies, conservative management, and surgical closure are recommended in those more complex cases. Fistula closure with local, regional or free flaps has been described. Next, we will present the case of a 67-year-old mastic patient with a history of a pharyngocutaneous fistula after a total laryngectomy in a previously irradiated neck, with poor response to conservative treatment and postoperative torpid evolution, so we decided to perform surgical closure with a pectoral fasciocutaneous flap which provides versatility, a satisfactory aesthetic result and lower times and costs than a free flap. We suggest that it should be within the surgical arsenal of otolaryngologist and head and neck surgeons.