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Inicio Enfermería Clínica (English Edition) Local treatment of a pharyngocutaneous fistula secondary to osteoradionecrosis
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Vol. 27. Issue 3.
Pages 193-202 (May - June 2017)
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Vol. 27. Issue 3.
Pages 193-202 (May - June 2017)
Nursing care
Local treatment of a pharyngocutaneous fistula secondary to osteoradionecrosis
Tratamiento local de un faringostoma secundario a osteorradionecrosis
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Olga González-Antolín
Servicio de Digestivo y Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Table 1. Focussed assessment: list of altered needs.
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Abstract

Radionecrosis is a late, and difficult to treat, complication of radiotherapy performed on head and neck tumours, and it is difficult to treat. This process causes significant damage, not only in the skin, but also in muscular, nervous, vascular, and bone structures. This, in turn, leads to airway and digestive tract involvement, as well as a functional loss and a cosmetic defect that usually requires reconstructive surgery. Therefore, this process is associated with a significant loss in the quality of life of patients and involves a long hospital stay for treatment, as well as the necessary support measures.

This article describes the local treatment of pharyngocutaneous fistula secondary to radiation therapy of squamous cell carcinoma of the right oropharynx. The lesion appeared two months after completing this treatment and required surgical reconstruction with a myocutaneous flap to repair the tissue defect.

In this context, an alginate wound dressing with silver was used, combined with a medium grip polyurethane foam with a silicone border. Within one month, there was autolytic debridement of all the necrotic tissue and the appearance of granulation tissue. At the same time, the infection was controlled, and a better management of the exudate was obtained, which provided a suitable surgical bed for the reconstruction.

Keywords:
Osteoradionecrosis
Fistula
Debridement
Resumen

La osteorradionecrosis es una complicación tardía y de difícil manejo que se produce como consecuencia de los tratamientos con radioterapia realizados en los tumores de cabeza y cuello. Ocasiona importantes daños, no solo en la piel sino también en estructuras musculares, nerviosas, vasculares y óseas produciendo una afectación de las vías aérea y digestiva que condicionan una pérdida funcional y un defecto estético que suele precisar de cirugía reconstructiva para su reparación.

Este proceso lleva asociado una importante pérdida en la calidad de vida del paciente y conlleva largos ingresos hospitalarios por los tratamientos y medidas de soporte necesarios.

En este artículo se describe el tratamiento local de un faringostoma secundario al tratamiento con radioterapia de un carcinoma epidermoide de orofaringe derecha. La lesión apareció a los dos meses tras finalizar la radioterapia, y precisó reconstrucción quirúrgica con un colgajo miocutáneo para reparar el defecto tisular.

En este contexto, se ha utilizado un apósito de alginato con plata asociado a una espuma de poliuretano de adherencia media con reborde de silicona, consiguiendo en el plazo de un mes el desbridamiento autolítico de todo el tejido necrótico y la aparición de tejido de granulación, a la vez que se controló la infección y se consiguió un mejor manejo del exudado, proporcionando así un lecho quirúrgico adecuado para la reconstrucción.

Palabras clave:
Osteorradionecrosis
Fístula
Desbridamiento

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