Objective: To explore the application of submental island flaps in repairing pharyngeal fistula after total laryngectomy.
Methods: From July 2002 to February 2006, 9 cases of concomitant pharyngeal fistula (including 7 cases of laryngeal carcinoma and 2 cases of hypopharyngeal neoplasms) were repaired with submental island flaps after total laryngectomy. All patients were male and their ages were 52-71 years (mean 61.8 years). Pharyngeal fistula occurred 5-62 days (mean 14.7 days) after total laryngectomy. The diameter of medial pharyngeal fistula ranged from 1.9 cm to 4.1 cm. All patients failed to respond to conservative therapy for 25-46 days. The size of submental island flap was 2.5 cm x 2.4 cm to 4.6 cm x 4.0 cm. After the pharyngeal fistula were repaired with submental flap, the donor site were sutured directly.
Results: All of the nine submental flaps were survived and no local necrosis or wound infection occurred. Incision at donor site healed by first intention and no obvious scar formed. Fistula occurred 10 days after operation and was cured after symptomatic treatment in one patient who received radiotherapy before operation; other patients achieved the satisfactory results of one-stage repair. The gastric tube was pulled out 14 to 22 days after operation, all of the patients have no sense of swallow obstruction. Nine patients were followed up for 10-38 months (mean 27 months). The appearance of neck was satisfactory.
Conclusion: Because of its short distance, abundant blood supply, convenient operation and minimal donor-site morbidity, the submental island flap is a good alternative method in repairing pharyngeal fistula.