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A 45-year-old patient presented with refractory salivary fistula, attributed to multiple surgery and Botulinum toxin, following lateral parotidectomy. He underwent fractionated radiotherapy of the remaining parotid gland including the fistula opening (total dose of 30 Gy) at our clinic. In time, fistula secretion could be inhibited completely. Although the indication for radiotherapy for such fistulas is rare since Botulinum toxin has been in use, it should still be considered in refractory disease courses.

We report on a seventy-year-old woman who developed a non-union of the distal radius with infection of the ulnocarpal joint after having sustained a fracture. The fistula, the distal ulna and the ulnocarpal joint were resected. Two months later we removed the non-union and carried out open reduction and internal fixation of the radius with a palmar plate. Good functional and cosmetic results were achieved.

Background: Pharyngo-vertebral fistulas - especially with delayed diagnosis - are a rare but grave reported complication in cervical spine surgery., Patients and Methods: We present a patient, sent postoperatively from Italy after cervical spine surgery to our department. The patient has developed a pharyngo-vertebral fistula with transspinous course to the dorsal neck skin due to infected spondylodesis., Case Report: In the presented patient, the successful closure of the pharyngo-vertebral fistula with transspinous course was made after diverse revisions at the anterior side with a platysma flap, at the posterior one with a drain., Review of the Literature: Aetiology, diagnostic work-up and treatment opinions are discussed in a detailed literature review., Conclusion: To the best of the authors' knowledge the presented pharyngo-vertebral fistula with transspinous course to the dorsal neck skin as a complication after anterior cervical spine surgery has not been reported in the literature before.

Background: Pelvic osteomyelitis is a bacterial infection of the pelvine skeleton. Apart from rare haematogen diffusion, it can occur after pelvic trauma or operation. Furthermore, it exists a sterile osteitis pubis after repetitive periostial microtrauma. Chronic progressions are possible. Further problems are fistulas and abscesses. With involvement of symphysis or iliosacral joint, the development of septic pelvine instability is possible. Due to the anatomic complexity of the pelvis, this affection can be neglected or underdiagnosed., Methods: We have analysed septic pelvic operations performed during 1997 to 2006. We excluded septic affections of the hip joint after joint replacement. In 15 cases we found both radiological and microbiological signs of osseous inclusion in terms of pelvic osteomyelitis., Results and Conclusion: 15 patients were operated after preoperatively performed bacterial asservation and conventional X-ray, fistula scanning and pelvic CT scans. In 3 cases we placed drainages into abscess formations under CT-guidance. In 14 cases osseous infected areas existed in the pelvic skeleton and we performed a local bony resection. In 3 patients we performed removal of bacterially contaminated metal implants. In 3 cases an additional pelvic instability due to involvement of the symphysis was present. Here we resected the infected joint and performed an arthrodesis to reestablish the pelvic ring stability. Due to the localisation of the infected pelvic bone, different regimes of therapy are necessary. Iliac osteomyelitis can be treated by resection or sequestrectomy, pubic osteomyelitis or sterile osteitis can be treated similarly. Septic iliosacral joint infections as well as septic symphysis joint infections can be treated by resection and can lead to a pelvic ring instability. Simple revision surgery of fistula without removement of the fistula's origin will fail, as 9 of our patients had already had several fistula revisions without any signs of healing.

Background: Acquired, benign esophago-respiratory fistula occurs as a rare complication of different disorders., Study Design: Over a period of 30 years, 37 patients with acquired, benign esophago-respiratory fistulas were treated at the authors' institutions. 35 of the 37 patients were operated upon. Acute operation involved primary repair of the trachea and esophagus, or intubation of the gullet and/or gastrostomy. Elective operations were performed on 13 patients., Results: Complications were observed in 14 patients. There were 4 cases with anastomotic leakage (all of them on the neck). Direct closure was carried out in 2 patients; the remaining 2 cases healed spontaneously. None of the 4 patients died. Seven of the 37 patients died (18.9%). This seems acceptable in view of the severity of the cases and the extension of the operations., Conclusions: 1. The causes of a majority of the esophago-respiratory fistulas in this material are connected with the complications of corrosive injury and peptic stricture of the esophagus. 2. The well-known fact that most of these fistulas occur in the right chest is confirmed. 3. Gastrostomy and/or intubation of the gullet seems to be the best solution for this lesion in the acute cases and in severely ill patients. 4. In elective cases, reconstruction is suggested, if possible in one step.

A 66-year-old woman with a chronic traumatic lymph fistula is described. Using the almost atraumatic fluorescence micro-lymphography the fistula could be precisely localized within the ulcer. Lymph flow from deep channels was rhythmic. This previously unknown phenomenon of rhythmic retrograde flow in a lymphatic fistula is probably due to the activity of contractile segments of lymph collectors and an important factor for the non-healing of ulcers.

Purpose: The purpose of the study was to determine the value of computed tomography (CT) in demonstrating fistulae in comparison with conventional radiographic methods., Methods: In a prospective study 25 patients were evaluated by conventional radiographic methods and CT., Results: The identification of the fistulous tract was possible with CT in 27 of 29 cases, whereas 2 fistulae could only be detected by indirect signs. Furthermore, CT showed a larger extent of the fistulous tract in 5 patients and revealed complications such as inflammatory mass, abscess or osteomyelitis in 11 cases., Conclusion: CT seems to be superior in demonstrating the extent of a fistulous tract and provides valuable information on the surrounding structures.

Background: The pharyngocutaneous fistula presents the most common complication after laryngectomy. Despite applying methods of pharyngeal closure, local factors such as irradiation may cause healing disturbances and the development of pharyngeal fistula. Before the nasogastric feeding tube is removed, an additional radiologic control with water-soluble contrast medium is recommended in literature in case of normal clinical healing., Methods: The radiologic method was compared with a newly developed sonographic examination technique. Using the so-called "aerophagia maneuver" in sonography, an arising of peripharyngeal air before the "aerophagia maneuver" or a peripharyngeal mass lesion was an uncertain criterion for a pharyngeal fistula. Peripharyngeal air may be seen also due to infection with anaerobic bacteria, and peripharyngeal mass lesion may be caused by seroma or hematoma. In sonography, tissular air is seen typically, in a hyperechoic reflex with distal repetitions., Results: Radiologic examination of the pharynx in 18 laryngectomy patients revealed fistulas in three cases., Conclusions: Our experiences have shown so far that sonographic examination in combination with the so-called "aerophagia maneuver" prove to be reliable or ascertaining pharyngeal closure after laryngectomy.

The common therapy of a persistent bronchocutaneous fistula is the operative endoscopic repair of the leak, the parietal pleurectomy or the endoscopic pleurodesis with different agents. Therefore the thoracotomy with all the risks for the patient can be avoid. Complications seen in the thoracoscopic treatment are low and often the result of techniqual problems. However there must be an alternative therapy for patients with a high operational risk. In our case we treated a bronchocutaneous persistent fistula by the instillation of iodized talc effectively. Although talc and others agents are used in the therapy of malignant pleural effusions, the talc poudrage in the therapy of bronchocutaneous fistulas is a good alternative treatment for patients in a bad condition.

The case history of a 75 year old man is demonstrated, who developed an abscess in the scar after B-II-resection 30 years ago. In this abscess S. typhi murium was detected. Diabetes mellitus was an additional risk factor. A review of the literature is given concerning extraintestinal manifestations of salmonellosis with emphasis to the predisposing conditions.