Abstract
Purpose :
Nasocutaneous fistulas (NCF) are a known complication following en bloc resection of lacrimal outflow system malignancies (LOSM). This study evaluates the incidence of NCF development and describe methods of surgical repair in patients with LOSM.
Methods :
All patients who underwent resection of LOSM with reconstruction and posttreatment protocol at the University of Miami between 1997 and 2021 were studied in this retrospective case series.
Results :
24 patients were included in the study. 11 (46%) developed postoperative NCF. All NCF developed within 1 year of surgical resection/completion of radiation therapy, with most cases occurring within the first 3 months. NCF occurred in 2 patients who underwent surgical resection alone and 9 patients who underwent surgery with adjuvant radiation. 10 of the 11 patients underwent revisional surgery to close the fistula including: local myocutaneous transposition (8/10), paramedian forehead flap (4/10), and microvascular free flap (1/10). In 9 of the 10 patients, the various methods of surgical repair failed with recurrence of fistula shortly after reconstruction. One patient underwent a failed local transposition flap followed by a failed paramedian forehead flap. He ultimately underwent a radial forearm free flap, which was successful for 2 years until the fistula recurred.
Conclusions :
NCF typically occur within the first year of LOSM surgical resection, especially following adjuvant radiation. Local tissue transfer or paramedian forehead flaps are unlikely to result in successful closure of the defect in irradiated tissue beds. Free flaps remain the most viable repair technique although long-term closure of the fistula remains unpredictable.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.