Problems Associated with Vacuum-assisted Closure System in Postoperative Head and Neck Fistula

Background: Head and neck fistula is one of the most troublesome complications after head and neck surgery. Fistulas sometimes cause fatal complications such as carotid artery rupture. Vacuum-assisted closure (VAC) system was reported to be useful for managing complex wounds.

Methods: A retrospective chart review was performed.

Results: We confirmed 7cases with complex fistulas of the head and neck. The VAC system was successful in completely closing the fistula in five of the seven patients. Two patients needed surgical treatment under local anesthesia. In these two cases, the failure resulted from poor collapsibility of the neck tissue caused by prior radiotherapy and deficient sealing of the fistulas around the mandible.

The VAC system removes infectious materials and promotes blood flow and healing of complicated wounds. However, when treating complicated wounds the VAC system may be problematic as it can be difficult to obtain an airtight seal because of the intricate contours and stomas of the mandible. Patients with pharyngocutaneous fistulas close to a tracheostoma need a feeding tube to prevent aspiration pneumonia. However, the VAC system enables patients to consume foods without aspiration during the treatment.

Conclusions: The VAC system is a feasible treatment option for closing head and neck fistulas when the sealing of the fistula tract is satisfactory. However, it is difficult to close the fistula using the VAC system alone in patients with postradiotherapy, fistulas around the mandible, or infection with drug resistant bacteria.