Vol.102 No.6 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 102 No. 6 June 2009
Experience with Wound Dressings for Surgical Wound Dehiscence and Oropharyngeal Fistulae after Excision of Head and Neck Cancer
Kaori Kayano and Kotaro Okamoto
(Nantan General Hospital)
Taketoshi Shimada and Hitoshi Bamba
(Kyoto Prefectural University of Medicine)
We report 3 patients in whom occlusive wound dressings were effective and shortened the healing time during the treatment of surgical wound dehiscence and oropharyngeal fistula formation after the excision of head and neck cancers.
Case 1 showed carcinoma of the right buccal mucosa. Surgical resection of the tumor was performed, including the involved facial skin, followed by reconstruction with an anterolateral thigh flap. However, a cervical abscess occurred with wound dehiscence between the soft palate and flap, as well as an oro-cutaneous fistula. Drainage and re-suture of the wound was carried out, followed by dressing with SORBSAN? (calcium alginate fiber), DuoDERM? (hydrocolloid) CGF?, and Hydrosite? (aqueous polyurethane) after debridement and washing with physiological saline. The fistula was closed on the 28th day after the operation, and epithelization of the wound was achieved by the 38th postoperative day.
Cases 2 and 3 had carcinoma of the hypopharyx and larynx, respectively. Total pharyngolaryngoesophagectomy with immediate gastric pull-up and total laryngectomy were performed, respectively. However, a cervical abscess occurred with pharyngeal suture dehiscence, and bilateral or anterior pharyngeal-cutaneous fistulae formed in each case. Drainage and dressing with AQUACEL?Ag (Hydrofiber?dressing: carboxymethylcellulose containing ionic silver) were performed in a similar way, respectively. In case 2, the fistula on the left closed by the 58th day after the operation, while that on the right improved and was closed on the postoperative 89th day with a hinge flap. On the other hand, in case 3, the fistula closed by the 45th postoperative day, while epithelization of the wound was achieved on the 59th day.
In particular, among the wound dressing materials that we employed this time, AQUACEL?Ag was effective for achieving the closure and epithelization of oropharyngeal fistulae associated with infection, because it has a marked capacity to absorb fluid including saliva without lateral spread through the dressing, while its silver content has bactericidal and sterilizing properties.
Key words :oropharyngeal fistula, occlusive dressing, AQUACELAg,
Hydrofiberdressing, moist wound healing