Use of a collagen patch for management of pharyngocutaneous fistula after hypopharyngeal reconstruction.

Abstract

Pharyngocutaneous fistula is one of the fatal complications occurring after head and neck reconstruction with neck node dissection. Even minor salivary leakage from the fistula could cause serious infection and threaten the viability of the transferred flap or even lead to the rupture of jugular vein. In such cases, proper management is difficult, and the chances for recurrence rise. We used a collagen patch (TachoComb) for fistula prevention and treatment. TachoComb, a collagen patch integrated with activated thrombin and fibrinogen, was used to prevent postoperative fistula formation in the initial reconstruction by applying them on sites with a high risk of salivary leakage. The patch was applied to 16 patients who had hypopharyngeal reconstruction, and the results were evaluated and compared with patients who had reconstruction without a collagen patch. A fistula occurred in 1 (6%) of 16 patients who received the collagen patch, whereas it occurred in 6 (14%) of 43 patients who underwent reconstruction without the collagen patch. In addition, the collagen patch was also used to treat postoperative fistula in 2 patients, and the results were successful after a single revision. Our results suggest that the collagen patch can be effective in the prevention and treatment of postoperative fistula after head and neck reconstruction, especially pharynx and cervical esophagus.

• Authors: Dong Won Lee, Seum Chung, Won Jai Lee, Eun Chang Choi, Dae Hyun Lew
• Journal: The Journal of craniofacial surgery (J Craniofac Surg) Vol. 21 Issue 6 Pg. 1674-6 (Nov 2010) ISSN: 1536-3732 [Electronic] United States
• PMID: 21119398 (Publication Type: Case Reports, Comparative Study, Journal Article)

Chemical References

• Drug Combinations
• Hemostatics
• Tissue Adhesives
• tachocomb
• Fibrinogen
• Collagen
• Aprotinin
• Thrombin

Topics

• Aged
• Aprotinin (administration & dosage, therapeutic use)
• Collagen (administration & dosage, therapeutic use)
• Cutaneous Fistula (prevention & control)
• Drug Combinations
• Fibrinogen (administration & dosage, therapeutic use)
• Free Tissue Flaps
• Hemostatics (administration & dosage, therapeutic use)
• Humans
• Hypopharyngeal Neoplasms (surgery)
• Hypopharynx (surgery)
• Laryngectomy
• Male
• Neck Dissection
• Pharyngeal Diseases (prevention & control)
• Pharyngectomy
• Postoperative Complications (prevention & control)
• Plastic Surgery Procedures (methods)
• Respiratory Tract Fistula (prevention & control)
• Retrospective Studies
• Risk Factors
• Saliva
• Surgical Flaps
• Suture Techniques
• Thrombin (administration & dosage, therapeutic use)
• Tissue Adhesives (administration & dosage, therapeutic use)