Utility of negative‐pressure wound therapy for orocutaneous and pharyngocutaneous fistula following head and neck surgery

Abstract

Background: Because of the difficulty of airtight sealing and risk of salivary contamination, negative-pressure wound therapy (NPWT) has rarely been applied for postoperative fistula following head and neck surgery; thus, its utility remains unclear. Methods: We applied NPWT in 34 patients who developed orocutaneous and pharyngocutaneous fistula after head and neck surgery. Here we retrospectively analyzed the utility of NPWT for managing those fistulas. Results: Thirty-two patients (94.1%) underwent NPWT as scheduled without adverse events. In 28 patients (82.4%), fistula closure was completed only by NPWT, and the mean period to fistula closure was 30.4 days. The mean period to closure did not differ significantly between fistulas with (21.7 days) and without (39.1 days) previous irradiation. Conclusions: Airtight sealing can be maintained and postoperative fistula can be closed by NPWT with a high success rate, even after previous irradiation. NPWT is an effective and minimally invasive treatment for postoperative fistula. K E Y W O R D Sfistula closure, head and neck cancer, negative-pressure wound therapy, orocutaneous fistula, pharyngocutaneous fistula

Impact of Previous Irradiation on Wound Healing after Negative Pressure Wound Therapy in Head and Neck Cancer Patients—A Systematic Review

“…Another frequent indication for the use of NPWT in the head and neck are pharyngocutaneous fistulas post laryngectomy or pharyngolaryngectomy [8]. Different approaches have been used for the management of fistula tracts in the pharynx with the use of either conventional external foam dressing attached to a vacuum device or the use of intraluminal NPWT for the closure of the tract or the optimization of pharyngeal reconstruction [11,15]. Conventional daily dressing management is a cumbersome process involving a prolonged hospital stay and an additional financial burden on the healthcare system, with no convincing results.…”

“…The undulating wound surfaces and movements of the neck pose problems of air leak and frequent dressing change with no effective outcome. Small maneuvers, such as the shallow insertion of foam dressing in the fistulous tract, the use of a tracheostomy tube with bulb inflation, a slight increase in negative pressure for large sized openings, bending or slightly turning the neck to the ipsilateral side, and the use of intraluminal foam dressings if the fistula is too large, seem to be successful [15,31]. Similarly, there is controversy regarding the placement of NPWT instead of synthetic or inert materials such as reconstruction titanium plates, synthetic vascular grafts, and mesh.…”

“…In particular, the presence of oro-cutaneous or pharyngocutaneous fistula did not make a difference (p = 0.93) in terms of the duration of wound healing, although the duration of application of NPWT was a bit prolonged in pharyngocutaneous fistulas. However, no comparisons between the conventional dressings and NPWT for fistula closure have been made [15]. This is the critical area where NPWT should be a part of surgeon's armamentarium, particularly in a multidisciplinary set up where one could not afford wound-related complications resulting in prolonged hospital stays, additional costs, and delays in further treatment.…”

“…Short case series reporting less than 3 patients were further excluded. After full-text revision, 23 articles were excluded for various reasons explained in the PRISMA flow chart [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Hence, 15 studies published in English and 1 published in German were included for further investigation.…”

Fistula Management in Head and Neck Cancer

“…The mean time to fistula closure was 30.4 days, and did not differ with previously irradiated patients. 31 A systematic review by Lin et al also revealed success with NPWT. Although the exact method of NPWT varied, reported fistula closure rate ranged from 78 to 100% between studies.…”