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. 2025 Jul;47(7):1989-1995.
doi: 10.1002/hed.28111. Epub 2025 Feb 24.

Tissue-Plug Modification of Pectoralis Major Myocutaneous Flap for Intractable Pharyngocutaneous Fistula Repair

Chia-Kai Hsu  1 , Fang-Yu Hsu  2   3 , Hung-Chi Chen  1 , Jian-You Ji  4 , En-Wei Liu  1   4
Affiliations

Tissue-Plug Modification of Pectoralis Major Myocutaneous Flap for Intractable Pharyngocutaneous Fistula Repair

Chia-Kai Hsu et al. Head Neck. 2025 Jul.

Abstract

Objective: To evaluate the feasibility and effectiveness of a novel tissue-plug modification of the pectoralis major myocutaneous flap for repairing intractable pharyngocutaneous fistulas, especially in difficult-to-access defects.

Materials and methods: The novel technique involved designing a tissue-plug modification of pectoralis major myocutaneous flap and suspension sutures. Cadaver studies were performed to refine the surgical method before clinical application. This method was applied to five patients. Postoperative outcomes, complications, and follow-up data were analyzed.

Results: All five patients underwent successful fistula repair using the tissue-plug method. Healing was achieved without recurrent leakage in four patients, while one required permanent enteral feeding due to preexisting tongue dysfunction. Two patients experienced tracheal strictures, which were resolved with additional interventions. Swallowing function improved, and imaging confirmed fistula resolution.

Conclusion: The tissue-plug modification of the pectoralis major myocutaneous flap is a viable and effective approach for managing intractable pharyngocutaneous fistulas, particularly in cases with posterior oropharyngeal defects or prior radiation exposure. Further studies with larger cohorts are needed to validate its long-term efficacy and outcomes.

Level of evidence: Level 4.

Keywords: head and neck surgery; pectoralis major myocutaneous flap; pharyngocutaneous fistula; salvage surgery; tissue‐plug.

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