Kadota Hideki, Oryoji Chikafumi, Fukushima Seita, Shimamoto Ryo, Kamizono Kenichi, Yoshida Sei
Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan.
Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan.
Auris Nasus Larynx. 2024 Dec;51(6):964-970. doi: 10.1016/j.anl.2024.09.008. Epub 2024 Oct 9.
Peritracheostomal pharyngocutaneous fistula (PCF), a direct connection between the PCF and tracheal stoma due to a skin defect, is among the most problematic complications after total laryngectomy or pharyngolaryngectomy. Peritracheostomal PCFs can cause lethal complications, including severe pneumonia or carotid blowout, secondary to salivary leakage directly into the tracheal stoma, and their management is challenging without early invasive surgical closure. We aimed to evaluate the utility of our novel and minimally invasive combined local skin flap placement and negative-pressure wound therapy (NPWT) method for the management and conservative closure of peritracheostomal PCFs.
We retrospectively enrolled patients who developed a peritracheostomal PCF from July 2015 to September 2021 at our institution and affiliated hospitals. Postoperative PCFs were all initially managed with appropriate wound bed preparation. Subsequently, a small local flap of healthy, lower neck skin was elevated and transferred anterior to the PCF to replace the peritracheostomal skin defect. The flap served to provide a sufficient surface for film dressing attachment and facilitated airtight sealing during NPWT. We initiated NPWT after confirming the local skin flap was firmly sutured to the tracheal mucosa. A flexible hydrocolloid dressing was applied to the peritracheostomal skin flap, and a film dressing was placed on the flexible hydrocolloid dressing and surrounding cervical skin. We inserted the NPWT foam shallowly into the fistula tract and applied negative pressure (73.5-125 mmHg). NPWT was continued until the PCF was closed or became so small that salivary leakage was minimal and could be managed by conventional compression dressings.
We enrolled six patients [male, n = 6; mean age, 66.5 years (range, 57-80 years)]. NPWT was applied for an average of 18.2 days (range, 2-28 days). During NPWT, air leakage occurred once (2 cases), only a few times (2 cases), or not at all (2 cases). In all patients, complete fistula closure was achieved in an average of 28.2 days (range, 15-55 days) after the start of NPWT, and no patient required further surgical intervention. There were no lethal complications (e.g., severe pneumonia) during treatment.
Our method of combined local flap placement and NPWT enabled effective management of salivary aspiration and accelerated wound healing, which allowed conservative fistula closure in all patients. We believe combined local flap placement and NPWT should be considered a first-line treatment for intractable peritracheostomal PCF.
气管造口周围咽皮肤瘘（PCF）是全喉切除术或咽喉切除术后最棘手的并发症之一，它是由于皮肤缺损导致咽与气管造口直接相通。气管造口周围PCF可导致致命并发症，包括严重肺炎或颈动脉破裂，这是由于唾液直接漏入气管造口所致，且在未早期进行侵入性手术闭合的情况下，其处理具有挑战性。我们旨在评估我们新颖的微创联合局部皮瓣置入和负压伤口治疗（NPWT）方法用于气管造口周围PCF的处理和保守闭合的效用。
我们回顾性纳入了2015年7月至2021年9月在我们机构及其附属医院发生气管造口周围PCF的患者。术后PCF均首先进行适当的伤口床准备。随后，掀起一块颈部下方健康皮肤的小局部皮瓣，并将其转移至PCF前方以替代气管造口周围的皮肤缺损。该皮瓣用于为贴膜敷料附着提供足够的表面，并在NPWT期间便于气密密封。在确认局部皮瓣牢固缝合至气管黏膜后开始NPWT。在气管造口周围皮瓣上应用柔性水胶体敷料，并在柔性水胶体敷料及周围颈部皮肤上放置贴膜敷料。将NPWT泡沫浅插入瘘管并施加负压（73.5 - 125 mmHg）。持续NPWT直至PCF闭合或变得非常小，以至于唾液漏出极少且可通过传统压迫敷料处理。
我们纳入了6例患者[男性，n = 6；平均年龄66.5岁（范围57 - 80岁）]。NPWT平均应用18.2天（范围2 - 28天）。在NPWT期间，漏气发生过一次（2例）、仅发生过几次（2例）或根本未发生（2例）。所有患者在开始NPWT后平均28.2天（范围15 - 55天）实现了瘘管完全闭合，且无患者需要进一步手术干预。治疗期间无致命并发症（如严重肺炎）。
我们的局部皮瓣置入与NPWT联合方法能够有效处理唾液误吸并加速伤口愈合，从而使所有患者实现了瘘管的保守闭合。我们认为局部皮瓣置入与NPWT联合应被视为难治性气管造口周围PCF的一线治疗方法。
