Reconstruction of Pharyngocutaneous Fistula with Radial Forearm Free Flap: A Case Report

Pharyngocutaneous fistula formation is a serious complication after total laryngectomy and its incidence varies from 7.6% to 50%. It leads to a prolonged hospitalization and complicated rehabilitation. Although many reconstruction methods have been introduced, each has its own merit and demerit and there is no single perfect answer. In our study, the fistula was reconstructed with inner lining using hinge method and radial forearm free flap. The operation was performed in 5 patients who underwent pharyngocuatneous fistula after total laryngectormy. We obtained a satisfactory reconstruction of the fistula and natural neck contouring using this method in all cases. Only 1 patient had complication of wound infection. However, the patient was healed with conservative antibiotics therapy. We believe the radial forearm free flap with hinge flap is the optimal method for circumferential reconstruction of pharyngocutaneous fistula. In comparison with other reconstructive techniques, the radial forearm free flap offers the best combination of flap reliability and low donor site morbidity. This method also allows patients to shorten the hospitalization and meet their cosmetic needs.

Limited Bilateral Facial Translocation with Le Fort I and Modified Le Fort II For Removal of Basal Sphenoidal Meningocele: A Case Report

Surgical treatment of skull base tumors are a challenge because of their location. These lesions were considered nonoperable for surgical morbidity and mortality and in many cases radical removal of the tumor was not possible because satisfactory surgical access to these areas was difficult to achieve. However, the facial translocation access to this area meets the current underlying principle of skull base approaches, minimizes brain retraction while maximizing skull base visualization. We completely exposed this area by approaching with limited bilateral facial translocation with Le Fort I and modified Le Fort II in basal sphenoidal meningocele patient. This provides direct access, excellent visualization of the ethmoid, sphenoid, nasopharynx and practically all surgical margins. Through this panoramic approach, one can easily expose the skull base lesions and operate on this area under direct visual and manual control. It also makes possible functional reassembly of soft tissue and the skeleton, plays an important role in producing a subsequent excellent facial appearance.