Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Otorhinolaryngol. Nov 28, 2015; 5(4): 93-104
Published online Nov 28, 2015. doi: 10.5319/wjo.v5.i4.93
Management of post-operative fistula in head and neck surgery: Sweeping it under the carpet?
Nguyen Thien Khanh, N Gopalakrishna Iyer
Nguyen Thien Khanh, SingHealth Duke-NUS Head and Neck Centre, Singapore 169610, Singapore
N Gopalakrishna Iyer, SingHealth Duke-NUS Head and Neck Centre, Cancer Therapeutics Research Laboratory, National Cancer Centre Singapore, Singapore 169610, Singapore
Author contributions: Nguyen KT and Iyer NG solely contributed to this paper.
Conflict-of-interest statement: We declare no conflict of interest in the writing of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: N Gopalakrishna Iyer, MBBS (Hons) (Singapore), PhD (Cantab), FRCS (Gen), FAMS, Associate Professor, Senior Consultant, and Head of SingHealth Duke-NUS Head and Neck Centre, Cancer Therapeutics Research Laboratory, National Cancer Centre Singapore, 11 Hospital Dr, Singapore 169610, Singapore. gopaliyer@nccs.com.sg
Telephone: +65-64268000 Fax: +65-62256283
Received: February 5, 2015
Peer-review started: February 7, 2015
First decision: March 28, 2015
Revised: August 30, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: November 28, 2015
Abstract

The most dreaded complication in head and neck surgery is the development of fistula. Fistulas are common and devastating. The prevalence and the risk factors that contribute to fistula formation after head and neck procedures were discussed briefly. The main goal of this manuscript is to discuss current management of head and neck fistula. We believed that the best management strategy for head and neck fistulas is prevention. We recommend a holistic preventive approach during the perioperative period. The roles of different types of wound products and hyperbaric oxygen therapy were also discussed and highlighted. We also discussed the operative repair of fistulas, which relies on the tenet of providing well-vascularized tissue to an area of poor wound healing. Most often, the surgeon’s preference and range of operative skills dictate the timing and the type of repair. We highlighted the use of the pectoralis major, a well-known flap, as well as a novel technique in the surgical repair of complex, difficult-to-heal head and neck fistula.

Keywords: Orocutaneous fistula, Pharyngocutaneous fistula, Fistula, Head and neck surgery, Head and neck surgery complications, Carotid blowout

Core tip: Fistulas after head and neck surgery is the most dreaded complication for good reasons: they are common, they occur in the sickest group of patients, and they are devastating physically and psychologically. The best treatment for fistulas is prevention. We discussed in details steps that can be taken to optimize patients and to reduce the risk of fistula formation. As we discussed up-to-date evidence on the conservative and surgical managements of fistula, we highlighted areas that need improvements and benefit from further researches.