Stripping of a fistula for complete second branchial cleft.

Complete fistulas of the second branchial cleft have a complicated course between the internal and external carotid arteries, crossing the hypoglossal and glossopharyngeal nerve. Therefore, surgical excision implies a tedious dissection of the fistula between the neck vessels and nerves and the multiple or large incisions have major cosmetic consequences. In cases of complete fistulas, we report a more simple method by stripping. Using a guide wire fixed to the first 2cm of the fistula, the fistulous tract is stripped completely inside out to its pharyngeal opening by pulling the oral end of the guide wire. This technique uses a limited skin incision with an excellent cosmetic result and very low morbidity; and furthermore, it shortens the procedure and hospitalisation time. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.