Predictors predisposing to orocutaneous fistula occurrence following free flap reconstruction

Abstract

ObjectivesTo explore the possible risk factors of orocutaneous fistula (OCF) development in free flap reconstruction of the tongue/floor of the mouth (TFOM).MethodsData of patients who underwent free flap reconstruction of the TFOM were retrospectively analyzed. The association between clinicopathologic variables and OCF occurrence was analyzed using univariate and multivariate analyses.ResultsAltogether, 469 patients were enrolled. OCF occurred in 43 patients with a rate of 9.2%. The univariate analysis revealed the negative effects of smoking, preoperative albumin level, cachexia, T4 stage, neck dissection, entire resection of the floor of the mouth (FOM), segmental mandibulectomy, and surgical site infection on OCF occurrence. The multivariate analysis confirmed the independence of cachexia (p<0.001, 4.386[1.883–9.472]), tumor stage (p<0.001, 2.738[1.482–6.629]), entire FOM resection (p<0.001, 6.332[2.110–14.432]), and surgical site infection (p<0.001, 5.376[1.998–11.218]) in affecting the OCF development.ConclusionsOCF development following free flap reconstruction of the TFOM was relatively uncommon, but significantly associated with presence of cachexia, T4 stage, entire FOM resection, and surgical site infection.

Prosthetic Management of Flap-Related Complications Following Glossectomy in Locally Advanced Tongue Cancer

“…Managing the development of flap-related complications can be challenging, and the formation of a fistula subsequent to free flap reconstruction for the tongue is significantly correlated with factors such as cachexia, advanced tumor stage (T4), complete resection of the floor of the mouth, and surgical site infection. 7 9 To prevent fistula formation, a reliable and suitably sized skin paddle, along with multilayer mattress sutures that distribute tension are imperative to minimize tear of the suture line, dehiscence, and fistula. 3 4 Fistulas and infections frequently coexist, creating a harmful pattern where one issue can trigger the other.…”

“… 6 7 Prompt and effective treatment of infections is crucial to minimize the development of a fistula. 9 The appropriate management approach for flap-related complications can be determined based on their presentation. Typically, patients may require adequate debridement, flap inset adjustment, and wound repair.…”

“…6,8 However, in the setting of recent radiation therapy, the tissues are poorly vascularized and fibrotic, the mobility of soft tissue may be restricted, and delayed healing decreases the likelihood of a successful secondary reconstruction. 9 Frequently, prosthetic appliances have been used in the management of these complications to create a barrier and seal the oral cavity from the external environment. 8 To the best of our knowledge, this is the only case series that describes prosthetic management of flap-related complications following glossectomy in three patients treated for locally advanced tongue cancer.…”

“… 6 8 However, in the setting of recent radiation therapy, the tissues are poorly vascularized and fibrotic, the mobility of soft tissue may be restricted, and delayed healing decreases the likelihood of a successful secondary reconstruction. 9 Frequently, prosthetic appliances have been used in the management of these complications to create a barrier and seal the oral cavity from the external environment. 8 …”