Fistula Analysis After Radial Forearm Free Flap Reconstruction of Hypopharyngeal Defects

Authors

  • Patricio Andrades MD,

    1. From the Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama, U.S.A.
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  • Stephen F. Pehler,

    1. From the Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama, U.S.A.
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  • Christopher F. Baranano MD,

    1. From the Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama, U.S.A.
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  • Jeffery S. Magnuson MD,

    1. From the Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama, U.S.A.
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  • William R. Carroll MD,

    1. From the Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama, U.S.A.
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  • Eben L. Rosenthal MD

    Corresponding author
    1. From the Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama, U.S.A.
    • Send correspondence to Dr. Eben L. Rosenthal, Division of Otolaryngology, University of Alabama in Birmingham, 563 Boshell Building, 1808 7th Avenue South, Birmingham, AL 35294-0012
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  • Presented at the Triological Society Meeting, Naples, Florida, U.S.A., January 10–12, 2008. Editor's Note: This Manuscript was accepted for publication February 20, 2008.

Abstract

Objective/Hypothesis: To evaluate risk factors and management options for fistula formation after hypopharyngeal reconstruction using the radial forearm free flap reconstruction.

Study Design: Retrospective cohort study.

Methods: Patients undergoing radial forearm free flap for hypopharyngeal reconstruction were retrospectively reviewed. A total of 104 patients underwent this procedure between 2001 and 2007. Fistulas were classified as mild or severe depending on the response to conservative management. Demographics, operative details, pathology, and postoperative course were recorded as the prognostic variables. Univariate analysis and a logistic regression model were used to identify associated factors.

Results: Pharyngocutaneous fistula developed in 30 (28.8%) patients. Recurrence, cancer stage, cancer location, type of ablative surgery, and the addition of other oncologic procedures were identified as significant predictors of fistula formation. Fistula significantly increases hospital stay and recipient site complications such as flap survival, infection, and bleeding. Functional results such as diet, deformity, and socialization were also negatively affected by fistula development. One third of the cases responded to conservative management, and 20 cases required a surgical procedure to definitively close the fistulous track.

Conclusions: Fistula formation remains a significant cause of morbidity associated with hypopharyngealreconstruction. Postoperative course and successful preventive strategies are discussed.

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