Use of becaplermin in the closure of pharyngocutaneous fistulas

Background. We report on the contribution of recombinant platelet-derived growth factor-BB (becaplermin) in treating recalcitrant postlaryngectomy fistulas in two patients with head and neck cancer. Methods. Topical becaplermin was applied daily, with periodic wound assessment and photodocumentation. Results. The two patients with persistent fistula refractory to conventional management have demonstrated rapid improvement after topical application of becaplermin. Each wound exhibited an exuberant granulation response, with a 50% decrease in the size of wound at 1 week. The patients experienced eventual closure, with none having local recurrence of their cancer at 2 years' follow-up. Conclusions. Becaplermin seems to be a promising addition to traditional methods of treatment for postlaryngectomy fistulas. In patients with delayed healing, future studies will be required to determine the overall efficacy of such biologic response modifiers in the treatment of pharyngocutaneous fistulas and other chronic wounds of the head and neck.