A Novel Tube-Drainage Technique of Negative Pressure Wound Therapy for Fistulae after Reconstructive Surgery

Abstract

Background:Patients with head and neck or esophageal cancer who undergo resection and reconstructive surgery sometimes develop fistulae that exhibit delayed wound healing. We developed a novel negative pressure wound therapy (NPWT) that employs a Penrose drain. This case series report describes its effect on the wound healing and treatment duration of cancer patients with postoperative fistulae.Methods:This consecutive case series consisted of all patients from February 2014 to February 2017 who underwent resection and reconstruction for head and neck or esophageal cancer and who then developed a fistula that was treated with either NPWT or a second flap that did not resolve the fistula or led to fistula recurrence and was then treated with NPWT. A Penrose drainage tube was inserted into the fistula, and a NPWT device was applied.Results:Eleven patients (10 males, 1 female; mean age, 67.4 years) underwent NPWT for fistulae that arose after tumor resection and reconstruction (n = 6) or after fistula reconstruction (n = 5). The resection was for esophageal (n = 4), laryngeal (n = 3), oral (n = 2), and hypopharyngeal (n = 2) cancer. In 9 cases, 1 week of NPWT led to rapid and complete wound healing. In 2 cases, complete healing occurred after 3–4 weeks of NPWT.Conclusions:Our NPWT applies continuous negative pressure inside the fistula only and dramatically promoted fistula healing. This approach may work by cleaning the fistula and promoting mucosal surface adhesion. It is particularly effective when the tissue surrounding the fistula is soft due to fresh tissue transfer.

Management of postreconstructive head and neck salivary fistulae: A review of current practices

“…A total of 1156 studies were further narrowed down to 19 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] peer-reviewed publications, for a total of 132 patients ( Table 1) pharyngocutaneous fistulas (3.1%) were complicated by carotid blowout. (Table 2) Most salivary fistulas could be diagnosed clinically.…”

“…Secondly, NPWT has demonstrated wound adhesions capable of withstanding high swallowing pressures necessary to ensure complete wound healing. 26 Which is also partly the reason why simple suture repair of fistulas often fail 26 . Additionally, NPWT promotes wound healing by increasing blood flow, improving bacterial clearance, and stimulating granulation tissue growth 32 33 34 .…”

“…Another author 26 treated fistulas that were small and deep by inserting a Penrose drain through the fistulas before placing NPWT over the wound. They hypothesized that with the usual NPWT technique, uniform negative pressure may not be achieved along the entire length of the fistula.…”

Simple Method for Deep Insertion of Drainage Tube through a Small Skin Incision

“…This method is effective in large-volume liposuction, 2 volume reduction with liposuction for lymphedema, 3 liposuction for gynecomastia, 4 and treatment of fistula. 5 …”

Novel Blake drain with negative pressure in pediatric laparoscopic surgeries

“…A drainage tube is necessary to be retained for monitoring postoperative bleeding or exudation. In recent years, negative pressure drainage or vacuum sealing drainage (VSD) has been widely used in wound treatment [1]. However, VSD following a laparoscopic surgery requires to be cautiously applied.…”