{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:23:13Z","timestamp":1787822593604,"version":"build-2784847793"},"reference-count":84,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Total laryngectomy (TL) is still the standard treatment for advanced laryngeal and hypopharyngeal cancer, with pharyngeal reconstruction being a challenging determinant of outcomes. We searched PubMed\/MEDLINE, Scopus, and Web of Science from inception to July 2026 for studies reporting pharyngeal reconstruction techniques or fistula outcomes after TL. This narrative review synthesizes current evidence on reconstruction following TL across three domains: prevention, reconstruction, and management of pharyngocutaneous fistula (PCF). Defect classification into minimal, partial, and circumferential categories guides reconstructive decision-making, each supported by a distinct evidence stream. Risk stratification identifies prior radiotherapy, poor nutritional status, sarcopenia, and salvage setting as the strongest PCF predictors. For minimal defects, stapler-assisted closure reduces PCF risk in primary TL, and double-layer manual closure outperforms single-layer repair. Partial defects in the salvage setting benefit from vascularized tissue augmentation, with pedicled onlay flaps associated with lower fistula rates than primary closure or free flap patching. For circumferential defects, network meta-analytic data suggest that the free jejunal flap ranks highest for fistula prevention. Comparative cohort data indicate that anterolateral thigh flaps may offer better long-term speech outcomes. The optimal choice depends on the outcome prioritized. Salivary bypass tubes represent the most consistently supported adjunct for fistula and stenosis prevention. PCF management follows a stage-based approach: conservative care for early fistulas, negative pressure wound therapy as a bridge in subacute cases, and vascularized flap reconstruction for chronic or refractory fistulas.<\/jats:p>","DOI":"10.3390\/life16091426","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:00:35Z","timestamp":1787821235000},"page":"1426","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharyngeal and Cervical Reconstruction and Fistula Management Following Total Laryngectomy: Contemporary Strategies and Evidence"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4334-0967","authenticated-orcid":false,"given":"Maximilian George","family":"Dindelegan","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Institute of Oncology Prof. Dr. Ion Chiricu\u021b\u0103, 400015 Cluj-Napoca, Romania"},{"name":"Department of Surgery-Practical Abilities, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alma Aurelia","family":"Maniu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 4\u20136 Clinicilor Street, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Diana","family":"Gherman","sequence":"additional","affiliation":[{"name":"Department of Surgery-Practical Abilities, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania"},{"name":"Department of Surgery II, County Clinical Emergency Hospital, Clinicilor Street, No. 3\u20135, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u0103zvan Alexandru","family":"Ciocan","sequence":"additional","affiliation":[{"name":"Department of Surgery-Practical Abilities, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania"},{"name":"Department of Surgery II, County Clinical Emergency Hospital, Clinicilor Street, No. 3\u20135, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9808-5580","authenticated-orcid":false,"given":"Cosmin Ioan","family":"Faur","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine Alumni, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Regina Maria Dental Department, Regina Maria Private Healthcare Network, 014416 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5911-983X","authenticated-orcid":false,"given":"Alex Victor","family":"Or\u0103dan","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Institute of Oncology Prof. Dr. Ion Chiricu\u021b\u0103, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hunor Levente","family":"Horvath","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 4\u20136 Clinicilor Street, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8415-555X","authenticated-orcid":false,"given":"Violeta","family":"Necula","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 4\u20136 Clinicilor Street, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"Haddad, R.I., Hicks, W.L., Hitchcock, Y.J., Jimeno, A., Juloori, A., Kase, M., Leizman, D., Maghami, E., Mell, L.K., and Mittal, B.B. (2026, August 24). NCCN Guidelines Version 2.2025 Head and Neck Cancers Continue NCCN Guidelines Panel Disclosures [Internet]. Available online: https:\/\/www.nccn.org\/guidelines\/guidelines-detail?category=1&id=1437."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.annonc.2020.07.011","article-title":"Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS\u2013ESMO\u2013ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Machiels","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Hut, A.R., Boia, E.R., Para, D., Iovanescu, G., Horhat, D., Mik\u0161a, L., Chiriac, M., Galant, R., Motofelea, A.C., and Balica, N.C. (2025). Laryngeal Cancer in the Modern Era: Evolving Trends in Diagnosis, Treatment, and Survival Outcomes. J. Clin. Med., 14.","DOI":"10.3390\/jcm14103367"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3681","DOI":"10.1007\/s12325-023-02561-7","article-title":"Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review","volume":"40","author":"Sanabria","year":"2023","journal-title":"Adv. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1001\/archotol.132.1.67","article-title":"Complications in Head and Neck Surgery A Meta-analysis of Postlaryngectomy Pharyngocutaneous Fistula","volume":"132","author":"Paydarfar","year":"2006","journal-title":"Arch. Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s00405-019-05718-9","article-title":"Risk factors of pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis","volume":"277","author":"Wang","year":"2020","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/00005537-199604000-00018","article-title":"Primary Closure of Pharyngeal Remnant After Total Laryngectomy and Partial Pharyngectomy: How Much Residual Mucosa Is Sufficient?","volume":"106","author":"Hui","year":"1996","journal-title":"Laryngoscope"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/hed.21712","article-title":"Closure of laryngectomy defects in the age of chemoradiation therapy","volume":"34","author":"Hanasono","year":"2012","journal-title":"Head Neck"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tonsbeek, A.M., Leidelmeijer, R., Hundepool, C.A., Duraku, L.S., Van der Oest, M.J.W., Sewnaik, A., and Mureau, M.A.M. (2024). Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis. Cancers, 16.","DOI":"10.3390\/cancers16101804"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105809","DOI":"10.1016\/j.oraloncology.2022.105809","article-title":"Circumferential pharyngeal reconstruction after total laryngopharyngectomy: A systematic review and network meta-analysis","volume":"127","author":"Costantino","year":"2022","journal-title":"Oral Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s00405-007-0562-z","article-title":"Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy","volume":"265","author":"Marchiori","year":"2008","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/coa.12905","article-title":"Post-Laryngectomy stricture and pharyngocutaneous fistula: Review of techniques in primary pharyngeal reconstruction in laryngectomy","volume":"43","author":"Walton","year":"2018","journal-title":"Clin. Otolaryngol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1002\/hed.25638","article-title":"Preoperative low skeletal muscle mass as a risk factor for pharyngocutaneous fistula and decreased overall survival in patients undergoing total laryngectomy","volume":"41","author":"Bril","year":"2019","journal-title":"Head Neck"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.ejso.2016.05.017","article-title":"Systematic review and meta-analysis of the complications of salvage total laryngectomy","volume":"43","author":"Hasan","year":"2017","journal-title":"Eur. J. Surg. Oncol. (EJSO)"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1001\/jamaoto.2024.0103","article-title":"Reconstruction for Salvage Laryngectomy With Limited Pharyngectomy","volume":"150","author":"Moreno","year":"2024","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"400","DOI":"10.14639\/0392-100X-626","article-title":"Fistola faringocutanea dopo laringectomia totale: Analisi dei fattori di rischio, della prognosi e delle modalit\u00e0 di trattamento","volume":"35","author":"Busoni","year":"2015","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4131","DOI":"10.1007\/s00405-026-10129-8","article-title":"Stapler versus manual closure for pharyngeal repair after total laryngectomy: A systematic review and meta-analysis","volume":"283","author":"Albannai","year":"2026","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s40487-022-00193-5","article-title":"Stapler-Assisted Pharyngeal Closure After Total Laryngectomy: A Systematic Review and Meta-Analysis","volume":"10","author":"Lechien","year":"2022","journal-title":"Oncol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1002\/hed.23326","article-title":"Efficacy of stapler pharyngeal closure after total laryngectomy: A systematic review","volume":"36","author":"Aires","year":"2013","journal-title":"Head Neck"},{"key":"ref_21","first-page":"e28822","article-title":"Incidence of Pharyngocutaneous Fistula After Total Laryngectomy and Its Relationship With the Shapes of Mucosa Closure: A Meta-Analysis","volume":"14","author":"Chotipanich","year":"2022","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"145","DOI":"10.18203\/issn.2454-5929.ijohns20185303","article-title":"A review of pharyngeal mucosal closure technique in total laryngectomy","volume":"5","author":"Govindasamy","year":"2018","journal-title":"Int. J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_23","first-page":"363640","article-title":"Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy","volume":"2015","author":"Deniz","year":"2015","journal-title":"Surg. Res. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1177\/0145561320938918","article-title":"Is It Important Which Suturing Technique Used for Pharyngeal Mucosal Closure in Total Laryngectomy? Modified Continuous Connell Suture May Decrease Pharyngocutaneous Fistula","volume":"99","author":"Avci","year":"2020","journal-title":"Ear Nose Throat J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s12070-014-0704-8","article-title":"Comparative Study Between Double Layered Repair of Pharyngeal Mucosa Against Routine Single Layered Repair in Cases of \u201cTotal Laryngectomy with Partial Pharyngectomy\u201d in Respect To Formation of Pharyngo-cutaneous Fistula","volume":"67","author":"Shukla","year":"2014","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s12070-017-1108-3","article-title":"A Comparative Study of Pharyngeal Repair in Two Layers Versus Three Layers, Following Total Laryngectomy in Carcinoma of Larynx","volume":"69","author":"Saha","year":"2017","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5839","DOI":"10.1007\/s00405-022-07490-9","article-title":"Surgical prevention of pharyngocutaneous fistula in salvage total laryngectomy: A systematic review and network meta-analysis","volume":"279","author":"Costantino","year":"2022","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2991","DOI":"10.1002\/lary.31287","article-title":"Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta-analysis","volume":"134","author":"Williamson","year":"2024","journal-title":"Laryngoscope"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1177\/0194599820957962","article-title":"Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta-analysis","volume":"164","author":"Cabrera","year":"2020","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.radonc.2009.08.009","article-title":"Radiation-induced microenvironments\u2014The molecular basis for free flap complications in the pre-irradiated field?","volume":"93","author":"Mueller","year":"2009","journal-title":"Radiother. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/micr.30406","article-title":"Reconstruction of laryngopharyngectomy defects: Comparison between the supraclavicular artery island flap, the radial forearm flap, and the anterolateral thigh flap","volume":"39","author":"Reiter","year":"2019","journal-title":"Microsurgery"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4403","DOI":"10.1007\/s00405-016-4092-4","article-title":"Supraclavicular artery island flap (SCAIF): A rising opportunity for head and neck reconstruction","volume":"273","author":"Giordano","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1017\/S0022215124000902","article-title":"140-year history of pharyngoesophageal reconstruction","volume":"138","author":"Butskiy","year":"2024","journal-title":"J. Laryngol. Otol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4103\/ijps.IJPS_79_17","article-title":"Outcomes following pharyngeal reconstruction in total laryngectomy-institutional experience and review of literature","volume":"51","author":"Balasubramanian","year":"2018","journal-title":"Indian J. Plast. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1002\/cncr.24947","article-title":"Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy","volume":"116","author":"Yu","year":"2010","journal-title":"Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00405-004-0809-x","article-title":"Reconstruction of the hypopharynx with U-shaped pectoralis major myocutaneous flap after total pharyngo-laryngectomy","volume":"262","author":"Morshed","year":"2005","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.bjps.2011.03.021","article-title":"Reconstruction of circumferential pharyngeal defects after tumour resection: Reference or preference","volume":"64","author":"Chan","year":"2011","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/SAP.0b013e3182583e80","article-title":"Pectoralis major myocutaneous flap for reconstruction of circumferential pharyngeal defects","volume":"71","author":"Burke","year":"2013","journal-title":"Ann. Plast. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1002\/hed.27526","article-title":"Long-term surgical and functional outcomes after anterolateral thigh flap and free jejunal transfer reconstruction of circumferential pharyngoesophageal defects","volume":"45","author":"Ishida","year":"2023","journal-title":"Head Neck"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1002\/lio2.430","article-title":"Reconstruction technique following total laryngectomy affects swallowing outcomes","volume":"5","author":"Harris","year":"2020","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Chen, W.F., Chang, K.P., Chen, C.H., Shyu, V.B.H., and Kao, H.K. (2013). Outcomes of Anterolateral Thigh Flap Reconstruction for Salvage Laryngopharyngectomy for Hypopharyngeal Cancer after Concurrent Chemoradiotherapy. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0053985"},{"key":"ref_42","first-page":"420","article-title":"Reconstruction of partial hypopharyngeal defects following total laryngectomy: Pectoralis major myofascial versus myocutaneous flaps","volume":"84","author":"Khoo","year":"2023","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1097\/01.prs.0000200622.13312.d3","article-title":"Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap","volume":"117","author":"Yu","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_44","first-page":"655","article-title":"Free flap microvascular pharyngeal closure results in improved dysphagia-specific quality of life following total laryngectomy","volume":"45","author":"Cleere","year":"2022","journal-title":"Eur. J. Plast. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/00020840-200304000-00003","article-title":"Pharyngocutaneous fistula","volume":"11","author":"Makitie","year":"2003","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_46","first-page":"243","article-title":"Analysis of Risk Factors for Pharyngocutaneous Fistula after Total Laryngectomy with Particular Focus on Nutritional Status","volume":"35","author":"Mattioli","year":"2015","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1136\/tc.2005.015263","article-title":"Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: A systematic review","volume":"15","author":"Theadom","year":"2006","journal-title":"Tob. Control"},{"key":"ref_48","first-page":"102557","article-title":"Utility of the Montgomery salivary tubes for preventing pharyngocutaneous fistula in total laryngectomy","volume":"41","year":"2020","journal-title":"Am. J. Otolaryngol.-Head Neck Med. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2608","DOI":"10.1002\/hed.27169","article-title":"Salivary bypass tube in total laryngectomy: Systematic review and meta-analysis","volume":"44","author":"Costantino","year":"2022","journal-title":"Head Neck"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamaoto.2016.2981","article-title":"Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: A consensus review and recommendations from the enhanced recovery after surgery society","volume":"143","author":"Dort","year":"2017","journal-title":"JAMA Otolaryngol. Neck Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1002\/hed.23591","article-title":"Effect of perioperative proton pump inhibitors on the incidence of pharyngocutaneous fistula after total laryngectomy: A prospective randomized controlled trial","volume":"37","author":"Stephenson","year":"2015","journal-title":"Head Neck"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1017\/S0022215117002390","article-title":"Primary versus secondary tracheoesophageal puncture: Systematic review and meta-analysis","volume":"132","author":"Chakravarty","year":"2017","journal-title":"J. Laryngol. Otol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Degni, E., Lai, S., Ciccarelli, C.C., Yesilli Puzella, G., Crescio, C., Tropiano, P., Fois, V., Parrilla, C., Galli, J., and Bussu, F. (2025). Safety of Primary Tracheoesophageal Puncture in Patients Submitted to Enlarged Total Laryngectomy with Pectoralis Major Reconstruction. J. Pers. Med., 15.","DOI":"10.3390\/jpm15090435"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2669","DOI":"10.1002\/hed.27788","article-title":"A Primary fit tracheoesophageal puncture in primary versus salvage laryngectomy: Short- and long-term complications and functional outcomes","volume":"46","author":"Kanyo","year":"2024","journal-title":"Head Neck"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"106089","DOI":"10.1016\/j.oraloncology.2022.106089","article-title":"Factors predicting pharyngocutaneous fistula in patients after salvage laryngectomy for laryngeal malignancy\u2014A multicenter collaborative cohort study","volume":"134","author":"Fitzgerald","year":"2022","journal-title":"Oral Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1067\/mhn.2000.110617","article-title":"Pharyngocutaneous fistula as a complication of total laryngectomy: Review of the literature and analysis of case records","volume":"123","author":"Cavalot","year":"2000","journal-title":"Otolaryngol.-Head Neck Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/lio2.112","article-title":"Salivary fistula: Blue dye testing as part of an algorithm for early diagnosis","volume":"2","author":"Kiong","year":"2017","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/S0194-5998(99)70224-X","article-title":"Early detection and treatment of postoperative pharyngocutaneous fistula","volume":"121","author":"Friedman","year":"1999","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Locatello, L.G., Licci, G., Maggiore, G., and Gallo, O. (2021). Non-surgical strategies for assisting closure of pharyngocutaneous fistula after total laryngectomy: A systematic review of the literature. J. Clin. Med., 11.","DOI":"10.3390\/jcm11010100"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/(SICI)1097-0347(199903)21:2<131::AID-HED6>3.0.CO;2-F","article-title":"Postlaryngectomy pharyngocutaneous fistula: Incidence, predisposing factors, and therapy","volume":"21","author":"Ferrari","year":"1999","journal-title":"Head Neck"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Piazza, C., Montenegro, C., and Vander Poorten, V. (2025). Preventing and managing pharyngocutaneous fistula after total laryngectomy\u2014A narrative review. Front Oncol., 15.","DOI":"10.3389\/fonc.2025.1597538"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s00268-003-7400-2","article-title":"Oxygen in Wound Healing\u2014More than a Nutrient","volume":"28","author":"Tandara","year":"2004","journal-title":"World J. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s11523-012-0233-x","article-title":"Hyperbaric oxygen therapy and cancer\u2014A review","volume":"7","author":"Moen","year":"2012","journal-title":"Target. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1001\/jamaoto.2013.6143","article-title":"Intraluminal negative pressure wound therapy for optimizing pharyngeal reconstruction","volume":"140","author":"Asher","year":"2014","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.anorl.2013.12.001","article-title":"Negative-pressure wound therapy for the treatment of pharyngocutaneous fistula","volume":"131","author":"Loaec","year":"2014","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.12968\/bjon.2013.22.Sup4.S15","article-title":"Pain associated with negative pressure wound therapy","volume":"22","author":"Waldie","year":"2013","journal-title":"Br. J. Nurs."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1002\/hed.26684","article-title":"Modified vacuum-assisted closure (EndoVAC) therapy for treatment of pharyngocutaneous fistula: Case series and a review of the literature","volume":"43","author":"Steinbichler","year":"2021","journal-title":"Head Neck"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"7099","DOI":"10.3390\/curroncol29100557","article-title":"Botulinum Neurotoxin A in the Treatment of Pharyngocutaneous Fistula after Salvage Surgery in Head and Neck Cancer Patients: Our Preliminary Results","volume":"29","author":"Marchese","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"3967","DOI":"10.1007\/s12070-024-04756-y","article-title":"Incidence and Management of Pharyngo Cutaneous Fistula Following Total Laryngectomy\u2014A Single Institutional 10 Years Experience","volume":"76","author":"Shanmugam","year":"2024","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1016\/j.bjps.2020.12.096","article-title":"Management of postreconstructive head and neck salivary fistulae: A review of current practices","volume":"74","author":"Khoo","year":"2021","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/01.sap.0000221640.23003.07","article-title":"Management of salivary fistulas after microvascular head and neck reconstruction","volume":"57","author":"Hyman","year":"2006","journal-title":"Ann. Plast. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"530","DOI":"10.5999\/aps.2017.00906","article-title":"Risk factors of and treatments for pharyngocutaneous fistula occurring after oropharynx and hypopharynx reconstruction","volume":"44","author":"Bin","year":"2017","journal-title":"Arch. Plast. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"157","DOI":"10.2340\/00015555-2786","article-title":"Need for improved definition of \u201cchronic wounds\u201d in clinical studies","volume":"98","author":"Kyaw","year":"2018","journal-title":"Acta Derm.-Venereol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.21037\/apm-22-1475","article-title":"A review of pharyngocutaneous fistula management in head and neck malignancies","volume":"12","author":"Chiu","year":"2023","journal-title":"Ann. Palliat. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2147\/OAS.S198038","article-title":"Optimal Management of Post-Laryngectomy Pharyngo-Cutaneous Fistula","volume":"13","author":"Molteni","year":"2020","journal-title":"Open Access Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1097\/SAP.0b013e318225832a","article-title":"Surgical management of pharyngocutaneous fistula after total laryngectomy","volume":"68","author":"Mclean","year":"2012","journal-title":"Ann. Plast. Surg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/SAP.0000000000002769","article-title":"Surgical Outcome of Pharyngocutaneous Fistula After Total Laryngectomy","volume":"87","author":"Higashino","year":"2021","journal-title":"Ann. Plast. Surg."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Pecorari, G., Bissattini, F., Gamba, D., Pizzo, C., Motatto, G.M., and Riva, G. (2024). Deltopectoral Flap in Head and Neck Reconstruction. Medicina, 60.","DOI":"10.20944\/preprints202409.0260.v1"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1177\/0145561320951678","article-title":"Application of the Supraclavicular Artery Island Flap for Fistulas in Patients With Laryngopharyngeal Cancer With Prior Radiotherapy","volume":"101","author":"Li","year":"2022","journal-title":"Ear Nose Throat J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1758-3284-3-29","article-title":"Closure of post-laryngectomy pharyngocutaneous fistulae","volume":"3","author":"Bohannon","year":"2011","journal-title":"Head Neck Oncol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/micr.22464","article-title":"Repair of a large pharyngocutaneous fistula with a free jejunal patch flap after salvage laryngectomy: A case report","volume":"37","author":"Hirano","year":"2017","journal-title":"Microsurgery"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1055\/s-2007-992343","article-title":"Pharyngocutaneous fistula repair after radiotherapy and salvage total laryngectomy","volume":"23","author":"Iteld","year":"2007","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"E81","DOI":"10.1002\/hed.23911","article-title":"Repair of pharyngocutaneous fistula after total laryngectomy: A novel endoscopic approach","volume":"37","author":"Fink","year":"2015","journal-title":"Head Neck"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"E353","DOI":"10.1002\/hed.24000","article-title":"New double-layer design for 1-stage repair of orocutaneous and pharyngocutaneous fistulae in patients with postoperative irradiated head and neck cancer","volume":"38","author":"Sadigh","year":"2016","journal-title":"Head Neck"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/9\/1426\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:09:17Z","timestamp":1787821757000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/9\/1426"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":84,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["life16091426"],"URL":"https:\/\/doi.org\/10.3390\/life16091426","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]}}}