Management of post-operative fistula in head and neck surgery: Sweeping it under the carpet?

Table 1 We suggested the above preoperative considerations to reduce the risk of fistula formation: Level of evidence and references are included where applicable

Preoperativeconsiderations	Level of evidence	Ref.
Extend of surgery
Concurrent neck dissection	III	[29]
Sentinel lymph node biopsy	II	[75]
Extend of resection	-	-
Choice of flap
Short-term vs long-term complications	-	-
Use of prophylactic flap	III	[42,43]
Nutrition
For prophylactic gastrostomy	II, III	[45-48]
Against prophylactic gastrostomy	II, III	[49-51]
PEG is preferred over RIG	II	[52]
Improve preoperative nutritional status	-	-
Optimization of comorbidities
Treat comorbidities (hypothyroidism, diabetes, anemia)	-	-
MRSA decolonization	III	[58,59]
Antibiotics prophylaxis	III	[60]
Dental care	IV	[62]

PEG: Percutaneous endoscopic gastrostomy; RIG: Radiologically inserted gastrostomy.