Intraluminal Negative Pressure Wound Therapy for Optimizing Pharyngeal Reconstruction

Asher, Scott A.; White, Hilliary N.; Illing, Elisa A.; Carroll, William R.; Magnuson, J. Scott; Rosenthal, Eben L.

doi:10.1001/jamaoto.2013.6143

Cited by 26 publications

(28 citation statements)

References 43 publications

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“…In patients undergoing treatment for fistula closure, 15 had prior radiation exposure, 15 were diabetics, seven had a diagnosis of hypothyroidism, and six were malnourished. In fact, some patients had two or more of these risk factors and thus presented with compounded risk for fistula formation . Our study also indicated that fistulas most often formed following total or partial laryngectomy or following neck dissection.…”

Section: Discussionmentioning

confidence: 51%

“…The treatment length ranged from 2 to 58 days, with follow‐up lengths between 21 days to 2 years. The two largest case series in this subgroup reported 85% and 92% successful response rates among 13 and 12 patients, respectively . There were 15 cases with radiation exposure, 15 with DM, seven with hypothyroidism, and six with malnutrition.…”

Section: Resultsmentioning

confidence: 89%

“…Nevertheless, among the three largest studies that reported wound size, response rates were high and ranged from 89% to 100%. The largest study reported an 89% successful response rate among 69 patients …”

Section: Resultsmentioning

confidence: 99%

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Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach

et al. 2018

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Negative pressure wound therapy is useful for the management of head and neck wounds and should be considered for patients in whom wound healing is progressing insufficiently, including those with a history of head and neck cancer, oro-/pharyngocutaenous fistula, and trauma. Randomized controlled trials further comparing NPWT versus other modalities may be invaluable in further delineating its appropriate role. Laryngoscope, 2018.

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Section: Discussionmentioning

confidence: 51%

Section: Resultsmentioning

confidence: 89%

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Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach

et al. 2018

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“…Asher et al analysed 12 patients who underwent laryngopharyngectomy and subsequent pharyngeal reconstruction. Seven patients developed pharyngocutaneous fistulas.…”

Section: Resultsmentioning

confidence: 99%

“…For patients with pharyngocutaneous fistulas, intraluminal NPWT is an alternative treatment method. Asher et al used intraluminal NPWT to treat seven patients with pharyngocutaneous fistulas and five other patients requiring prophylactic treatment owing to perceived high risk of fistula formation. The researchers combined a continuous negative pressure of 125 mm Hg with regional or free tissue transfer.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: Outcomes and complications

Lin

Huang

Cheng

2019

International Wound Journal

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Fistula formation in head and neck wounds is considered one of the most challenging complications that a head and neck reconstructive surgeon may encounter. The current mainstay of treatment is aggressive surgical debridement followed by vascularised soft tissue coverage. Negative pressure wound therapy (NPWT) has been successfully used for the closure of complicated wounds for decades. This study analysed the outcomes and complications of NPWT in the management of head and neck wounds with fistulas. A systematic search of studies published between January 1966 and September 2019 was conducted using the PubMed, MEDLINE, EMBASE, and SCOPUS databases and using the following key words: “negative pressure wound therapy,” “head and neck,” and “fistula.” We included human studies with abstract and full text available. Analysed endpoints were rate of fistula closure, follow‐up duration, and complications if present. Nine retrospective case series (Level IV evidence) that collectively included 122 head and neck wounds with orocutaneous fistulas, pharyngocutaneous fistulas, and salivary contamination were examined. The number of patients included in each study ranged from 5 to 64. The mode of NPWT varied among the included studies, with most adopting a continuous pressure of −125 mm Hg. Mean durations of NPWT ranged from 3.7 to 23 days, and the reported fistula closure rate ranged from 78% to 100%. To achieve complete wound healing, six studies used additional procedures after stopping NPWT, including conventional wound dressings and vascularised tissue transfer. Information regarding follow up was provided in only three of the nine studies, where patients were followed for 5, 10, and 18 months. No serious adverse events were reported. NPWT for head and neck wounds with fistulas may be considered a safe treatment method that yields beneficial outcomes with a low risk of complications. The current data originated mainly from studies with low levels of evidence characterised by heterogeneity. Therefore, definitive recommendations based on these data cannot be offered. Additional high‐quality trials are warranted to corroborate the findings of this systematic review.

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Modified vacuum‐assisted closure (EndoVAC) therapy for treatment of pharyngocutaneous fistula: Case series and a review of the literature

et al. 2021

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BackgroundPharyngocutaneous fistula is a potential life‐threatening complication following head and neck surgery. There is only limited evidence about the efficacy of vacuum‐assisted closure (VAC) therapy and endoscopic vacuum‐assisted closure (EndoVAC) therapy for the treatment of pharyngocutaneous fistulas.MethodsIn this article, we report on a consecutive case series of six male patients with pharyngocutaneous fistula treated with a modified outside‐in EndoVAC technique. We also present a review of the current related literature.ResultsEndoVAC therapy alone was successful in five of the six patients (83.3%) with a median duration of EndoVAC therapy of 18.5 days (range: 7 to 32 days) and a median number of EndoVAC sponge changes of 4 (range: 1 to 9 changes). One patient needed additional reconstructive surgery after prior radiochemotherapy and jejunal transfer. No treatment‐related complications were observed.ConclusionEndoVAC therapy is an easy‐to‐perform, safe procedure for the treatment of pharyngocutaneous fistulae.

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Intraluminal Negative Pressure Wound Therapy for Optimizing Pharyngeal Reconstruction

Abstract: Intraluminal negative pressure wound therapy is feasible and safe. Future research should be conducted to determine its potential in optimizing pharyngeal reconstruction in high-risk patients.

Cited by 26 publications

References 43 publications

Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach

Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach

Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: Outcomes and complications

Modified vacuum‐assisted closure (EndoVAC) therapy for treatment of pharyngocutaneous fistula: Case series and a review of the literature

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