الفهرس 
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Abstract
Pharyngocutaneous fistula is a serious complication that occurs after total
laryngectomy operations. Its incidence varies and ranges from 2% to 66% according to different authors starting from year 1951 and ending in the year 2009.
The aetiological predisposing factors are grouped into 3 big groups:
1. Preoperative factors: which include: previous irradiation, systemic affections, comorbidity
index and the presence of previous tracheostomy. Systemic affections include: anaemia, inadequate control of nutritional status, diabetes, hepatic
dysfunctions, abnormal blood parameters, chronic obstructive lung disease and the presence of AIDS.
2. Operative factors: that includes mainly the type of closure of the pharynx and the extent of the tumours (TNM stage and the free safety margin during the operation). Also, the type of sutures used, are all important factors.
3. Postoperative factors: including the type of PO feeding, with or without the use of NGT. The presence of PO complications as: seroma, wound infections and failure of skin healing are the main PO predisposing factors.
The squeals of PCF include both: 1-Morbidity like delayed oral feeding,prolonged hospitalization with possible additional surgery, increased cost and exposure to hospital acquired infection. 2- Mortality with the fatal complication like the rupture of the carotid artery.
The prevention of PCF includes mainly the avoidance of all the predisposing factors and also the immediate and early management of fistula
formation in a conservative measure using local toilet with local control of infection.
Treatment of an established PCF is divided according to size of the fistula. The management of a small PCF is by local flaps around it. While big fistulas will involve closure either by myocutaneous flaps as pectoralis major and
latissimus dorsi myocutaneous flap; axial pedicled skin flaps as delto-pectoral axial flap or free vascularized skin flaps as radial free vascularized forarm flap.
Less commonly used flaps as fasciocutaneous island flap pedicled on the superficial temporal artery and submental artery island flap.