Planned Fistula

In patients with local and systemic risk factors at high risk of spontaneous fistula formation, the deliberate construction of a planned pharyngocutaneous fistula may be considered. A controlled pharyngostoma can be helpful in protecting the suture line and skin flaps in wounds that have undergone previous radiation or are under tight tension. A controlled fistula may be made by placing a large passive drain from the phayrnx to the skin, or with a midline controlled pharyngostoma along the pharynx or tongue base . Salivary flow is then temporarily channeled along the path of least resistance and directed away from major vessels or underlying microvascular anastomosis until definitive reconstruction is possible.

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