The fasciomyocutaneous pectoralis major flap for defect closure of a pharyngocutaneous fistula – A retrospective analysis at the Charité over the last 20 years

The occurrence of a pharyngocutaneous fistula (PCF) after a laryngectomy is a serious complication, which leads to a prolonged hospital stay and a worse prognosis. In addition to various conservative measures, free flaps, the pedicled fasciomyocutaneous pectoralis major flap (PML) is an established method for closing the fistula. The aim of the retrospective study is to identify possible factors that influence the success of closing a PCF with a PML. Between 2003 and 2023, 24 patients (8 women and 16 men) were treated with PCF at the Charité, Universitätsmedizin Berlin. The mean age was 61 years. All 24 patients had carcinoma (larynx n=13, hypopharynx n=11), 8 patients had suffered a recurrence, and 13 patients had previously been irradiated. All patients received surgical treatment using PML within 456 days (median 60) of the initial diagnosis of PCF. Closure of the fistula was successful in 46% and 54% developed a recurrent fistula. During the course of the disease, 58% of the patients died. The highest risk of recurrent fistulas occurred in irradiated patients, hypopharynx Ca. and in salvage laryngectomies. PCF is a morbidity-increasing and resource-intensive complication. The PML is a good therapeutic option due to its constant anatomical properties and low-complication elevation. To avoid PCF during salvage laryngectomy, a PML or pectoralis major myofascial flap should be evaluated for prophylaxis. Furthermore, ideal operating conditions should be created and premature surgical closure of the PCF should be avoided.