Use of platelet-rich plasma in irradiated patients to treat and prevent complications of head and neck surgery

Abstract

Nowadays, many patients facing head and neck oncological surgery have a history of tissue irradiation. This represents an important risk factor for postsurgical complications, including dehiscences and fistulas. Platelet-rich plasma (PRP) obtained from the patient’s blood represents an easy, fast and inexpensive method for the prevention and treatment of such complications. We present three cases of previously irradiated patients in which PRP was successfully used to prevent and treat postsurgical complications.

Challenging management of an enlarged tracheoesophageal fistula in an irradiated patient

“…This can be achieved in some cases by simply removing the VP and positioning a feeding tube (either a nasogastric tube or a tube inserted through the TEP) and a cuffed tracheal cannula and waiting 7–14 days for the spontaneous shrinkage to occur13; however, this method is generally effective only in normotrophic fistulas, a condition rarely evident in irradiated patients. Alternatively, TEF shrinkage may be achieved through injection of various materials around the fistula, such as hyaluronic acid, autologous fat, hydroxyapatite or PRP 3 13…”

“…At this point, various conservative attempts were made to reduce the diameter of the TEF: high-dose antireflux therapy, positioning of a shorter VP or a prosthesis with an extraflange on the tracheal side, injection of hyaluronic acid around the fistula, VP removal and spontaneous shrinkage of the TEF, a purse-string suture around the fistula with injection of platelet-rich plasma (PRP) obtained from the patient’s whole blood 3. As all conservative strategies failed, we decided to remove the VP and close the TEF, eventually considering a secondary repackaging later on.…”

“…Furthermore, tracheoesophageal puncture (TEP) is not immune to complications, the most common of which being leakage through or around the VP, valve extrusion or obstruction.The risk of perioperative and long-term complications increases as the patient’s age and comorbidity burden rises. In particular, a previous irradiation is a well-known risk factor, which makes tissues hypoxic, hypocellular and hypoperfused, and thus more prone to aberrant healing and postoperative complications 3 4…”