Simple Septocutaneous Free Flap Design for One-Stage Reconstruction of Pharyngocutaneous and Orocutaneous Fistulae

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Abstract

Reconstruction of pharyngocutaneous fistula (PCF) or orocutaneous fistula is always a challenging task. It has many causes and is especially related to radiation therapy after resection of head and neck cancers. There are many reports of surgical procedures for fistula repair. For example, 2-stage methods, methods of combining multiple flaps, and methods of using chimeric flaps have been reported. However, there is no established simple method as a treatment of choice. The authors describe 5 patients of head and neck fistulas and recommend a useful 1-stage reconstruction method using a double skin paddle free flap.

The authors modified the free flaps simply with a double skin paddle sharing 1 pedicle. The skin paddle of the flap was split into 2 parts, one skin island for inner mucosal coverage, and the other for outer skin resurfacing. The bridge between the 2 skin paddles was deepithelialized and then folded. To prevent leakage, a water-tight closure was ensured.

The double skin paddle free flap method was used in 5 patients. Two patients had orocutaneous fistula, and the other 3 patients had PCF due to irradiation. Flap losses did not occur, but wound dehiscence was noted in the 3 PCF patients. Repeat wound revision procedures were performed in these patients, and the end result was good.

Conventional methods are complex and require multiple flaps or repeat surgery. However, the double skin paddle free flap method allows for simple and effective 1-stage reconstruction using 1 flap, 1 pedicle, and 1 microanastomosis even for patients who received preoperative radiotherapy.

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