{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:06:37Z","timestamp":1782129997406,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100012544","name":"China Medical University, Taiwan","doi-asserted-by":"publisher","award":["DMR\u2010111\u2010177"],"award-info":[{"award-number":["DMR\u2010111\u2010177"]}],"id":[{"id":"10.13039\/501100012544","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the feasibility and effectiveness of a novel tissue\u2010plug modification of the pectoralis major myocutaneous flap for repairing intractable pharyngocutaneous fistulas, especially in difficult\u2010to\u2010access defects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>The novel technique involved designing a tissue\u2010plug 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\u2010up data were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All five patients underwent successful fistula repair using the tissue\u2010plug 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The tissue\u2010plug 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\u2010term efficacy and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level 4.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.28111","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T01:01:35Z","timestamp":1740531695000},"page":"1989-1995","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tissue\u2010Plug Modification of Pectoralis Major Myocutaneous Flap for Intractable Pharyngocutaneous Fistula Repair"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9915-3128","authenticated-orcid":false,"given":"Chia\u2010Kai","family":"Hsu","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang\u2010Yu","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery Chang Gung Memorial Hospital  Chiayi Taiwan"},{"name":"Craniofacial Research Center Chang Gung Memorial Hospital  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung\u2010Chi","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian\u2010you","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Medicine China Medical University  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En\u2010Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Department of Medicine China Medical University  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/OAS.S198038"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2017.00906"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13193\u2010022\u201001581\u2010z"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.14639\/0392\u2010100X\u2010626"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100030\u20101255339"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102407\u20102\u201013"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21833"},{"key":"e_1_2_9_9_1","volume-title":"Pharyngocutaneous Fistulas Following Total Laryngectomy Recent Advances in Wound Healing","author":"Nicolaescu A.","year":"2022"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.21037\/apm\u201022\u20101475"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12905"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coms.2014.05.010"},{"issue":"6","key":"e_1_2_9_13_1","first-page":"389","article-title":"Pectoralis Major Myocutaneous Flap for Head and Neck Reconstruction: Risk Factors for Fistula Formation","volume":"34","author":"Leite A. K.","year":"2014","journal-title":"Acta Otorhinolaryngologica Italica"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010016\u20104049\u20107"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjorl.2020.05.009"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000447603"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.5704\/MOJ.1807.015"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1990.01870080045013"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1563\/1548\u20101336\u201035.2.82"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.28111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T08:52:00Z","timestamp":1753260720000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.28111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,24]]},"references-count":18,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/hed.28111"],"URL":"https:\/\/doi.org\/10.1002\/hed.28111","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,24]]},"assertion":[{"value":"2024-12-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}