{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:44:24Z","timestamp":1787863464895,"version":"build-2784847793"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"06","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"vor","delay-in-days":1631,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2017,10,26]],"date-time":"2017-10-26T00:00:00Z","timestamp":1508976000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:p>Background  A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula.<\/jats:p>\n                  <jats:p>Methods  Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation.<\/jats:p>\n                  <jats:p>Results  A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P&gt;0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation.<\/jats:p>\n                  <jats:p>Conclusions  Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.<\/jats:p>","DOI":"10.5999\/aps.2017.00906","type":"journal-article","created":{"date-parts":[[2017,10,25]],"date-time":"2017-10-25T05:08:10Z","timestamp":1508908090000},"page":"530-538","update-policy":"https:\/\/doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction"],"prefix":"10.1055","volume":"44","author":[{"given":"Su Bin","family":"Do","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chul Hoon","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Joon","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byeong Jun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Soo","family":"Rho","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"ref1","first-page":"243","article-title":"Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status","volume":"35","author":"F Mattioli","year":"2015","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/00020840-200304000-00003","article-title":"Pharyngocutaneous fistula","volume":"11","author":"AA Makitie","year":"2003","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"ref3","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":"P Boscolo-Rizzo","year":"2008","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"ref4","first-page":"389","article-title":"Pectoralis major myocutaneous flap for head and neck reconstruction: risk factors for fistula formation","volume":"34","author":"AK Leite","year":"2014","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1002\/hed.23804","article-title":"Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors","volume":"37","author":"RA Dedivitis","year":"2015","journal-title":"Head Neck"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.amjoto.2014.08.017","article-title":"Pharyngocutaneous fistula after total laryngectomy: a single-institution experience, 2001\u20132012","volume":"36","author":"EM Benson","year":"2015","journal-title":"Am J Otolaryngol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.otohns.2005.07.025","article-title":"Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy","volume":"133","author":"J Galli","year":"2005","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1017\/S0022215100122406","article-title":"Radiotherapy and complications of laryngectomy","volume":"107","author":"AW McCombe","year":"1993","journal-title":"J Laryngol Otol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1002\/lary.20521","article-title":"The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx","volume":"119","author":"R Dirven","year":"2009","journal-title":"Laryngoscope"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/0194599810390914","article-title":"Salvage laryngectomy after primary radiotherapy: what are prognostic factors for the development of pharyngocutaneous fistulae?","volume":"144","author":"MC Aarts","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/(SICI)1097-0347(199801)20:1<22::AID-HED4>3.0.CO;2-5","article-title":"Pharyngocutaneous fistula following laryngectomy","volume":"20","author":"L Soylu","year":"1998","journal-title":"Head Neck"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00405-003-0643-6","article-title":"Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?","volume":"261","author":"KD Markou","year":"2004","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"9180","DOI":"10.1038\/srep09180","article-title":"Choice of flap affects fistula rate after salvage laryngopharyngectomy","volume":"5","author":"HK Kao","year":"2015","journal-title":"Sci Rep"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1055\/s-0034-1395417","article-title":"Pectoralis major myocutaneous flap versus free fasciocutaneous flap for reconstruction of partial hypopharyngeal defects: what should we be doing?","volume":"31","author":"JW Chao","year":"2015","journal-title":"J Reconstr Microsurg"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1177\/019459988509300114","article-title":"Nutritional status: a prognostic indicator in head and neck cancer","volume":"93","author":"GB Brookes","year":"1985","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1016\/j.bjps.2013.08.016","article-title":"The usefulness of triple layers suturing technique with frilled pectoralis major musculocutaneous flap for pharyngocutaneous fistula","volume":"67","author":"A Hamahata","year":"2014","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1002\/lary.23695","article-title":"Outcomes following pharyngolaryngectomy with fasciocutaneous free flap reconstruction and salivary bypass tube","volume":"123","author":"F Lopez","year":"2013","journal-title":"Laryngoscope"},{"key":"ref18","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":"E Loaec","year":"2014","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.e-aps.org\/upload\/pdf\/aps-2017-00906.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.e-aps.org\/journal\/view.php?doi=10.5999\/aps.2017.00906","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.5999\/aps.2017.00906.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T18:32:10Z","timestamp":1650479530000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.5999\/aps.2017.00906"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":18,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2022,4,20]]},"published-print":{"date-parts":[[2017,11]]}},"URL":"https:\/\/doi.org\/10.5999\/aps.2017.00906","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]},"assertion":[{"value":"2017-05-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-10-26","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-15","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}