Continuous negative pressure-flush through a dual tube for the treatment of a complicated pharyngeal fistula: A case report

Abstract

The treatment of pharyngeal fistulas is complicated. It is more difficult to deal with pharyngeal fistula following surgical treatment for hypopharynx carcinoma, particularly in cases of pectoralis major muscle flap repair. The present study describes the case of a 56-year-old man who presented with a highly-differentiated pharyngeal squamous cell carcinoma located at the right side of the hypopharynx. The patient underwent a total laryngectomy and a right functional carotid dissection and tracheostomy; this was followed by post-operative radiotherapy. A pharyngeal fistula subsequently developed, but an attempt to repair this with a pectoralis major muscle flap failed. The complicated pharyngeal fistula was treated via continuous negative pressure-flush through a dual tube, without the requirement for incision, daily dressing or antibiotics. The favorable patient outcome represented a positive result, which was also able to reduce the psychological burden of the patient and improve their quality of life.

Keywords: continuous negative pressure-flush; dual tube; pectoralis major muscle flap; pharyngeal fistula.

Figure 1.

Computed tomography scan revealing a huge fistula packed with iodoform gauze.

Figure 2.

Continuous negative pressure-flush through a dual tube. A small fistula was visible above the tracheal stoma fistula. Image captured on August 19, 2013.

Figure 3.

Healing after repair with pectoralis major muscle flap. Image captured on December 4, 2013.

Figure 4.

Electronic laryngoscopy examination showing the hypopharynx mucosal defect repaired with a pectoralis major muscle flap. Image captured December 4, 2013.