A fibrin seal closure technique for prolonged postoperative pharyngocutaneous fistula

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  • Yabuki Kenichiro
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine
  • Sano Daisuke
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine
  • Nishimura Goshi
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine
  • Hyakusoku Hiroshi
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine
  • Arai Yasuhiro
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine
  • Komatsu Masaki
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine
  • Taguchi Takahide
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine
  • Oridate Nobuhiko
    Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine

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  • 再発下咽頭癌に対する救済手術後に生じた難治性瘻孔に対してフィブリン糊の瘻孔内充填が有効であった1例

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A total pharyngo-laryngectomy with pharyngeal reconstruction by free jejunum transfer was performed due to recurrence of hypopharyngeal cancer after concurrent chemoradiotherapy (CCRT) in a 77-year-old male patient. Postoperatively, a pharyngocutaneous fistula developed at the site of jejunum-esophageal anastomosis. Application of trafermin (basic fibroblast growth factor: bFGF) spray, patch-graft reconstruction using a pectoral major muscular flap and covering by absorbable polyglycolic acid (PGA) felt were sequentially performed as closure of the fistula approached, resulting in a smaller residual fistula. The fistula was totally closed by fibrin seal closure on the 140th postoperative day.<br>Postoperative pharyngocutaneous fistula is a major complication of surgery for head and neck malignancies. In salvage surgery after radiotherapy or CCRT, this complication often bothers the surgeon because it usually requires a very long time to heal. Sealing the fistula by fibrin glue may be an effective procedure for prolonged postoperative pharyngocutaneous fistula.

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