The role of radiotherapy and musculocutaneous flaps in oropharyngocutaneous fistulas.

The development of oropharyngocutaneous fistulas after resection of the head and neck is a major cause of morbidity. In this retrospective review, we examined the role of radiotherapy and musculocutaneous flaps in the development and management of fistulas and found several significant factors associated with these fistulas. In patients with this complication, there is a significant decrease in postoperative hemoglobin and albumin levels and absolute lymphocyte counts. In addition, there is a significant reduction in lymphocyte counts in the irradiated patient. Musculocutaneous flaps play an invaluable role in the management of fistulas. In the irradiated patient, the healing of fistulas is a long and difficult process; the presence of a musculocutaneous flap is the only significant factor in the ability of the fistulas to heal spontaneously. If the fistulas are to close spontaneously, they will do so within 4 to 6 weeks. Fistulas that develop in the absence of a previously placed musculocutaneous flap are more severe than if a vascularized flap were present initially. Successful management of such fistulas is enhanced by use of vascularized extracervical tissue.