New double-layer design for 1-stage repair of orocutaneous and pharyngocutaneous fistulae in patients with postoperative irradiated head and neck cancer

Background The development of a postoperative orocutaneous fistula (OCF) or pharyngocutaneous fistula (PCF) in the irradiated tissues of patients with head and neck cancer represents a high burden of morbidity for the patient. With high postoperative recurrence rates, these fistulae result in a reconstructive challenge for the plastic surgeon. In this study, we propose a new double-layer design to successfully repair these fistulae in a 1-stage reconstruction. Methods Twelve patients with an average age of 56 years (range, 45-67 years) were operated on between January 2006 and December 2012 using this double-layer single-stage technique. All patients had received postoperative radiotherapy after their initial reconstruction. A circumferential turnover flap was designed and raised from the skin surrounding the fistula to recreate inner lining using a tension-free, water-tight repair. No debridement of the fistula itself was performed. The second-layer of the reconstruction, which represents the outer lining, was achieved with either a local or a free flap. Results Fistula size ranged from 0.8 × 0.5 cm to 3 × 3.2 cm with a mean size of 2 cm². The outer lining was achieved using a free flap in 5 cases and a local flap in 7 cases. All the flaps survived completely with no cases of postoperative infection, however, 1 case was complicated by mandibular plate exposure necessitating its removal. No major complication or recurrence has yet been encountered in any of our patients with a mean follow-up of 28 months (range, 12-78 months). Conclusion This 1-stage double-layer design can provide a reliable and relatively straightforward means of repairing OCF and PCF in the irradiated tissues of patients with head and neck cancer.