Citation Information :
Irizarry R, Sukato D, Sundaram K. Clinical Techniques: Downstate Fistula Formula Update. Int J Head Neck Surg 2022; 13 (4):99-101.
Aim: Review our case series of salvage total laryngectomies (STL) after 2010 using the downstate fistula formula (DFF) for the incidence of postoperative (post-op) pharyngocutaneous fistulas (PCF).
Background: Pharyngocutaneous fistulas (PCF) remains the most common complication after STL, even with the use of vascularized flaps at a rate of 30%. The DFF is a multipronged approach to prophylactically address risk factors contributing to PCF formation.
Technique: The DFF incorporates a watertight two-layer closure, pectoralis major myocutaneous flap reconstruction, antibiotic prophylaxis, delayed oral intake using a G-tube, salivary diversion, and an anti-reflux regimen.
Conclusion: Initial results of 11 patients treated by the DFF published in 2009 showed a 0% failure rate. A review of patients treated by DFF from 2010 continued to maintain a 0% failure rate.
Clinical significance: The use of the DFF in STL patients has reduced the incidence of PCF to zero with a reduced length of stay.
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