Total Approach to Postoperative Fistula After Head and Neck Reconstruction

Head and neck reconstructive surgery is a complex and lengthy procedure that carries a high postoperative complication risk. At our institution, the authors have successfully minimized fistula formation incidence following immediate reconstructive surgery after tumor resection by accurately assessing the post-tumor resection status and taking appropriate measures. The authors describe the approach of our institution to prevent fistulas during reconstruction and our response when fistulas occur. Using our theory, the authors investigated the presence of wound infection and fistula formation in 30 consecutive patients who underwent reconstructive surgery after head and neck cancer resection, as well as those who underwent a successful flap transfer. The cases with different reconstruction sites by tumor resection were the tongue in 11, mandible in 11, maxilla in 3, hypopharynx to cervical esophagus in 3, buccal mucosa in 1, and skull base in 1. Postoperatively, partial necrosis and infection of the flap occurred in 1 patient, whereby a pectoralis major myocutaneous flap was used. Two patients had minor wound infections that resolved with conservative treatment. No obvious gastrointestinal fistulas were observed. Head and neck reconstruction involves various critical components, including precise major surgical procedure performance like flap harvesting, flap suturing, and microsurgery. Although this is a complex and difficult surgery, by referring to the information in this report, we can minimize complication occurrence, including postoperative fistula formation, and perform reconstructive surgery with high safety.