Pharyngocutaneous and tracheoesophageal fistula closure using supraclavicular artery island flap.

BACKGROUND: Pharyngocutaneous fistula is a common complication of laryngopharyngeal surgery, being associated with increased morbidity and mortality. Classical regional and free flaps, frequently used in the treatment of this complication, have several limitations, including bulking, donor site morbidity and long operative time. The supraclavicular artery island flap (SCAIF) is a fasciocutaneous flap and presents as an alternative option with good results and without the previously stated limitations. We describe our experience with SCAIF in pharyngocutaneous and tracheoesophageal fistula closure. METHODS: Between April and December 2017, four patients with pharyngocutaneous and two patients with tracheoesophageal fistula underwent fistula closure with SCAIF. Clinical records were retrospectively reviewed. RESULTS: Pharyngocutaneous fistulae were associated with anterior esophageal wall defects ranging from 4 to 13.5 cm2. Tracheoesophageal fistulae defects were smaller (approximately 2 cm2). Fistula closure was achieved in all patients, oral diet was started on the 14th day post-operative and there were no signs of recurrence during follow-up. The donor area was complicated with the formation of hematoma in two patients. CONCLUSIONS: The SCAIF has unique features that makes it an ideal option for pharyngocutaneous and tracheoesophageal fistula closure, namely, reliable perfusion, quick and simple dissection, pliability and minor donor site morbidity. Local complications do not significantly affect long term morbidity of the donor area and can be avoided with simple measures.

Fournier's gangrene: a review of reconstructive options.

INTRODUCTION: Fournier's gangrene is a rapidly progressive necrotizing fasciitis of the genital and perineal tissues with a high mortality rate. Early diagnosis and treatment with fluid resuscitation, surgical debridement and wide-spectrum antibiotics are essential in the management of Fournier's gangrene. After primary treatment, reconstructive surgery is often necessary for coverage of soft-tissue defects. This review article aims to provide an overview of the main reconstructive procedures used in Fournier's gangrene. MATERIAL AND METHODS: A literature search was performed on the subject of reconstructive surgery in Fournier's gangrene. RESULTS: Techniques of reconstructive surgery for soft-tissue defects following Fournier's gangrene include skin grafts, local advancement flaps, scrotal flaps, multiple fasciocutaneous and myocutaneous flaps, and testicular transposition. The surgical goal is to achieve the best functional and cosmetic result possible with minimal morbidity. Advantages and disadvantages of each technique and potential indications are discussed. CONCLUSIONS: Characteristics of the defect, patient preference and surgeon experience should guide the choice of reconstructive procedure. Further comparative studies are needed to optimize results.

Changes in the characteristics of facial fractures in children and adolescents in Portugal 1993-2012.

We investigated the changes in the characteristics of facial fractures in children and adolescents during a 20-year period in Portugal to try to find out how to prevent such fractures in future. We reviewed the clinical records of patients aged 0-18 years old who had facial fractures treated at the Department of Plastic Surgery, São João Hospital, Porto, during the 20-year period 1993-2012. The patients were divided into two 10-year periods: January 1993 to December 2002, and January 2003 to December 2012, and these were compared and analysed. A total of 1416 patients with 2071 fractures were diagnosed. There was a significant reduction (p<0.001) in the number of patients treated during the two decades. In both groups the number of patients increased with increasing age (p<0.001), and there was a male preponderance in all age groups. Motor vehicle collisions were the main cause of the fractures, and the mandible was the most common site (49.7%). Other injuries were recorded in 1015 patients (71.7%), and the head and neck was the most common site in both decades. Facial fractures in children are usually associated with severe trauma, and their characteristics can be influenced by social and economic factors. Although the number of children injured has decreased significantly during the last decade, facial fractures remain common in Portugal.