Guidelines for Complications of Cancer Treatment Vol VIII Part B

However, more often than not, insertion of a wellvascularizedtissue is performed such as pectoralis majorflap. Free flaps are not advisable because of the infectedrecipient site; however they can be used for long standingfistulae where there is no evidence of infection.Adjuvant Radiotherapy Most centers do not recommend adjuvant radiotherapyin the presence of a fistula as this impedes the closure ofthe fistula and can lead to catastrophic complicationslike a carotid blowout. However, one study has reported that any delay of RTgreater than six weeks post-operatively increases therates of neck recurrence from 2.0% to 29.0%. Hence ajudicious decision regarding starting adjuvant therapyis required.References1. De Zinis L, Ferrari L, Tomenzoli D, Premoli G, ParrinelloG, Nicolai P. Postlaryngectomy pharyngocutaneousfistula: incidence, predisposing factors and therapy. HeadNeck 1999:21:131-138.2. Friedman M, Venkatesan TK, Yakovlev A, Lim JW,Tanyeri HM, Caldarelli DD. Early detection andtreatment of postoperative pharyngocutaneous fistula.Otolaryngol Head Neck Surg 1999;121:378-380.3. Qureshi SS, Chaturvedi P, Pai PS, Chaukar DA,Deshpande MS, Pathak KA, D’cruz AK.A prospectivestudy of pharyngocutaneous fistulas following totallaryngectomy. J Cancer Res Ther. 2005 Jan-Mar;1(1):51-6.4. Smith TJ, Burrage KJ, Ganguly P, Kirby S, Drover C.Prevention of postlaryngectomy pharyngocutaneous206