Closure of large oropharyngocutaneous fistulas using a folded extensive supraclavicular fasciocutaneous island flap

Although several techniques have been described for closing oropharyngocutaneous fistulas (OFs), large OFs remains a challenge. This clinical study assessed outcomes following the use of folded extensive supraclavicular fasciocutaneous island flaps (SFIFs) to close large OFs. Extensive folded SFIFs were designed to close large OFs following oropharyngeal cancer ablation in 11 patients (8 men, 3 women; mean age: 53.5 years). Fistula size ranged from 3.0 × 1.5 to 4.0 × 2.0 cm and skin paddle size ranged from 10 × 6 to 12 × 7 cm. SFIFs provided both inner and outer linings for OFs. All flaps survived, head and neck appearance was satisfactory, and no patient experienced a major complication. All patients resumed an oral diet and eventually regained normal speech abilities. No fistula recurrence or stricture developed after 6-18 months of follow-up. The folded extensive SFIF is a simple and reliable flap preferred for the reconstruction of large OFs.