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Fever during the early postoperative period traditionally has not been considered an indication of a postoperative wound infection or breakdown. Atelectasis is considered the most likely source for these early fevers. We studied 200 consecutive patients who underwent major head and neck surgery that involved reconstruction with a pharyngeal suture line. Patients were divided into 2 groups: those who had preoperative irradiation and those who did not. All patients had prophylactic antibiotic coverage, and all patients had identical suture material for closure. We showed a high correlation between fever (>101.5 degrees F) that developed in the first 48 hours and eventual fistula formation and wound infection. We also studied length of hospitalization and number of days until decannulation and resumption of oral feedings. Our data indicate that in those patients in whom fistulas developed, early detection led to earlier healing and rehabilitation.

Nearly 6,750,000 people suffer moderate to severe cancer-related pain each year. Unfortunately, 10% to 15% of these patients fail to achieve acceptable pain relief with conventional management. Spinal cord stimulation (SCS) has been used with increased frequency for successful treatment of intractable cancer pain. We present two cases of intractable, refractoryto-conventional treatment cancer pain that were successfully treated with SCS. Case 1 reports a 51-year-old male with burning pain at the left groin site of inguinal metastases, post-surgical and intraoperative radiation therapy for treatment of squamous cell carcinoma of the anus. Case 2 reports a 43-year-old woman with intractable, burning, throbbing, and shooting pain, post-debulking followed by radiation of a metastatic colon carcinoma. In both cases SCS implantation provided 90% to 100% pain relief, improved functioning and sleep, and discontinuation of pain medications, sustained through 12 months. Case Presentations Case 1The patient is a 51-year-old male who underwent anterior-posterior resection and intraoperative radiation therapy for squamous cell carcinoma of the anus. He later developed inguinal adenopathy, which was also irradiated because it contained secondary metastasis from the carcinoma of the anus. Approximately 4 months post-irradiation, he developed burning pain in the left groin at the site of the inguinal metastasis. The pain was described as hot and burning, occasionally sharp and shooting, with visual analog scale (VAS) scores at rest of 2 to 4 out of 10 in severity. The patient was most aggravated by the fact that, during activity, the pain escalated to a VAS score of 8 out of 10 and significantly limited his activities. Occasionally, sitting or getting off his feet would afford him some comfort; however, the pain never disappeared entirely.The patient had used ibuprofen, acetaminophen, gabapentin, cyclobenzaprine, amitriptyline, and topical ointments, but they did not provide any relief. Because codeine, oxycodone, and hydrocodone had caused a rash in the past, the use of opioids was limited. Darvocet, fentanyl patches, and ilioinguinal and iliohypogastric nerve blocks provided the patient with minimal pain relief. He was counseled on alternative options of treatment, including an intrathecal drug delivery system and spinal cord stimulation (SCS). He chose SCS.Once the decision has been made to proceed to SCS, a successful trial of percutaneous placement of temporary epidural leads must be performed before implantation of the entire SCS system. These temporary leads are connected to an external pulse generator, and patients typically wear them for a few days while

SCS provides an effective, alternative treatment option for select patients with cancer-related chest wall pain who have failed conservative treatment. SCS may provide pain relief with advantages over conservative treatments and more invasive techniques.