Treatment of pharyngocutaneous fistulae with a cork-design radial forearm free flap.

Pharyngocutaneous fistula is a dreaded complication after ablative surgery of the aerodigestive tract including the pharynx and larynx. This is a common problem for the surgeon. Two cases are presented with pharyngocutaneous fistula developing after total laryngectomy and radiation therapy. The fistula was reconstructed using a cork-design radial forearm free flap. Total obliteration of the fistula was obtained without complications. This new design provides the following advantages: extensive contact area between the flap and the inflamed surrounding tissue, discontinuity between the suture lines of the inner lining and the outer cover, and reinforcement of the suture line of the outer covering with skin graft. This method can be useful in reconstructing irradiated pharyngocutaneous fistulas.