Fistulas, either between oral cavity and external face or between oral and nasal cavity, are major complications after microsurgical head and neck reconstruction. Any flaw in surgical planning, design, and execution may lead to this untoward outcome. Once fistula develops, it may interface with oncologic treatment, endanger the reconstruction, and increase overall patient suffering. This article analyzes individual factors involved in development of fistulas in spite of successful transfer of a free flap and proposes treatment guideline.
Key points
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Oronasal and orocutaneous fistulae are among the untoward results of reconstructive microsurgery in head and neck cancer in spite of free flap viability.
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Complete obliteration of ablation-related dead spaces, adequate volume replacement, and water-tight closure of oral wounds ensure uneventful healing and prevent fistulae.
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Management of fistula ideally should not delay radiotherapy. However, reconstruction is timed based on wound condition, with consideration not to interrupt oncologic treatment.
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A second free flap may become necessary for the treatment of fistulae.
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