Clinical Techniques: Downstate Fistula Formula Update

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or more components of the formula were not used.Following the implementation of the formula, the first 11 cases performed by the senior author all healed successfully without unplanned fistula formation.Now, 10 years following implementation, outcomes performed by the same senior author are reported. TechniqueThe fistula reduction formula includes early gastrostomy, anti-reflux therapy (histamine type 2 blockade and proton pump inhibitor), broad-spectrum triple antibiotic therapy (cephalexin, metronidazole, and ciprofloxacin), a watertight two layer closure, PMMF interposition, and a controlled diverting pharyngostomy (Fig. 1). Pharyngeal ClosureReconstruction is performed in two tension free layers by either a horizontal or T closure based on available mucosa.The inner layer is closed by simple 3-0 submucosal continuous vicryl sutures with inverted mucosal edges.The second layer of serosa and remaining pharyngeal musculature is closed with simple interrupted 3-0 vicryl sutures.The third layer is a pectoralis major interposition muscle flap.The flap is held in place by Prolene sutures secured in place to the upper skin flap with retention buttons and removed 4 weeks later.

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