Novel approach of combined endoluminal and external vacuum therapy for wound healing disorders after salvage pharyngeal reconstruction.

Abstract

Objective: Patients with recurrent head and neck carcinoma are considered for salvage surgery if resectability with clear margins is achievable. However, postoperative complications such as wound healing disorders and pharyngocutaneous fistulas remain significant challenges. While various reconstructive surgical techniques exist, supportive vacuum therapy-both external and endoluminal-has been explored as an alternative treatment modality.

Type of study: We present a case report of a 60-year-old male patient with recurrent laryngeal cancer who underwent salvage laryngopharyngectomy following multiple previous surgical procedures and definitive radiochemotherapy. Due to persistent pharyngocutaneous fistula formation despite multiple reconstructions using pectoralis major flaps, an anterolateral thigh flap, and a fasciocutaneous deltopectoral flap, a novel approach combining endopharyngeal and external vacuum therapy was implemented.

Results: Over six weeks, with vacuum system changes performed twice weekly, the pharyngocutaneous fistula successfully closed, leading to complete wound healing.

Conclusion: This case demonstrates the potential effectiveness of a combined endopharyngeal and external vacuum therapy approach for treating persistent pharyngocutaneous fistulas when conventional surgical options are exhausted. Notably, the patient was able to resume oral food consumption following therapy, highlighting the functional benefits of this novel treatment strategy.