Coated collagen patches for closure of pharyngo-cutaneous fistulas

After laryngectomy or lateral pharyngotomy for treatment of laryngeal or hypopharyngeal cancer the occurrence of a pharyngo-cutaneous fistula is a challenging complication. Especially after previous radiotherapy and expanded surgical resections of mucosa the management is demanding. Besides the prolonged hospital stay, increased treatment costs and reduced quality of life, a delayed adjuvant treatment follows the development of a fistula. Treatment strategies range from conservative procedures comprising parenteral nutrition, antibiotics and local wound care to primary surgical closure or reconstructive tissue transfer. We report three cases of using the fibrin/thrombin-coated collagen patch TachoSil® as a solitary or adjuvant strategy in surgical treatment. In one patient primary closure of the fistula was achieved by transoral application of the collagen patch. In the other cases a not tension free primary suture was strengthened by the adjuvant use of TachoSil®. The healing process was rapid and straightforward in all patients. The use of TachoSil® may be indicated in between conservative treatment strategies and reconstructive surgery. After occurrence of a fistula the healing process is intended to be accelerated by primary closure with TachoSil® or by sealing of a primary suture.