Early detection and treatment of postoperative pharyngocutaneous fistula

Fever during the early postoperative period traditionally has not been cons idered an indication of a postoperative wound infection or breakdown. Atele ctasis is considered the most likely source for these early fevers. We stud ied 200 consecutive patients who underwent major head and neck surgery that involved reconstruction with a pharyngeal suture line. Patients were divid ed into 2 groups: those who had preoperative irradiation and those who did not. All patients had prophylactic antibiotic coverage, and all patients ha d identical suture material for closure. We showed a high correlation betwe en fever (>101.5 degrees F) that developed in the first 48 hours and eventu al fistula formation and wound infection. We also studied length of hospita lization and number of days until decannulation and resumption of oral feed ings. Our data indicate that in those patients in whom fistulas developed, early detection led to earlier healing and rehabilitation.