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Closure of tracheocutaneous fistula using prefabricated conchal bowl cartilage and a supraclavicular flap

Published online by Cambridge University Press:  09 July 2019

N Mundi ,
K B Patel ,
D H Yeh  and
A C Nichols
N Mundi*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Western University, London, Canada
K B Patel
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Western University, London, Canada
D H Yeh
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Western University, London, Canada
A C Nichols
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Western University, London, Canada
*
Author for correspondence: Dr Neil Mundi, Department of Otolaryngology – Head and Neck Surgery, Western University, London Health Sciences Centre – Victoria Hospital, Room B3 - 453, 800 Commissioners Road E., London, Ontario, Canada N6A 5W9 E-mail: Neil1.Mundi@lhsc.on.ca Fax: +1 (519) 685 8468
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Abstract

Background

Tracheocutaneous fistula represents one of the most troublesome complications of prolonged tracheostomy. Simple closure of a fistula can be ineffective, particularly in the context of prior surgery and adjuvant radiation. As such, modes of repair have expanded to include locoregional flaps and even free tissue transfers.

Objective

This paper describes a case of persistent tracheocutaneous fistula in an irradiated patient who had undergone previous unsuccessful attempts at repair.

Method and results

The use of regional fasciocutaneous supraclavicular flap with prefabricated conchal bowl cartilage resulted in successful closure of the tracheocutaneous fistula.

Conclusion

This represents a novel technique for closure of such fistulas in patients for whom previous attempts have failed. This mode of repair should be added to the surgeon's repertoire of reparative techniques.

Keywords

TracheaFistulaReconstructive Surgical Procedures
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 8 , August 2019 , pp. 727 - 729
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Dr N Mundi takes responsibility for the integrity of the content of the paper

References

1White, AK, Smitheringale, AJ. Treatment of tracheocutaneous fistulae in children. J Otolaryngol 1989;18:49–52Google Scholar
2Joseph, HT, Jani, P, Preece, JM, Bailey, CM, Evans, JN. Paediatric tracheostomy: persistent tracheo-cutaneous fistula following decannulation. Int J Pediatr Otorhinolaryngol 1991;22:231–6Google Scholar
3Mahadevan, M, Barber, C, Salkeld, L, Douglas, G, Mills, N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007;71:1829–35Google Scholar
4Tasca, RA, Clarke, RW. Tracheocutaneous fistula following paediatric tracheostomy--a 14-year experience at Alder Hey Children's Hospital. Int J Pediatr Otorhinolaryngol 2010;74:711–12Google Scholar
5Rob, CG, Bateman, GH. Reconstruction of the trachea and cervical oesophagus; preliminary report. Br J Surg 1949;37:202–5Google Scholar
6Grillo, HC. Tracheal replacement: a critical review. Ann Thorac Surg 2002;73:1995–2004Google Scholar
7Jackson, C, Babcock, W. Plastic closure of tracheocutaneous fistula. Surg Clin North Am 1934;14:199–221Google Scholar
8Drezner, DA, Cantrell, H. Surgical management of tracheocutaneous fistula. Ear Nose Throat J 1998;77:534–7Google Scholar
9Fujiwara, T, Nishino, K, Numajiri, T. Tracheal reconstruction with a prefabricated and double-folded radial forearm free flap. J Plast Recon Aesth Surg 2009;62:790–4Google Scholar
10Riedel, F, Reinhart, Goessler U, Grupp, S, Bran, G, Hormann, K, Verse, T. Management of radiation-induced tracheocutaneous tissue defects by transplantation of an ear cartilage graft and deltopectoral flap. Auris Nasus Larynx 2006;33:79–84Google Scholar
11Royer, AK, Royer, MC, Ting, JY, Weisberger, EC, Moore, MG. The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature. J Med Case Rep 2015;9:251Google Scholar
12Tatekawa, Y, Yamanaka, H, Hasegawa, T. Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: a case report. Int J Surg Case Rep 2013;4:170–4Google Scholar
13Teng, MS, Malkin, BD, Urken, ML. Prefabricated composite free flaps for tracheal reconstruction: a new technique. Ann Otol Rhinol Laryngol 2005;114:822–6Google Scholar
14Shinohara, H, Yuzuriha, S, Matsuo, K, Kushima, H, Kondoh, S. Tracheal reconstruction with a prefabricated deltopectoral flap combined with costal cartilage graft and palatal mucosal graft. Ann Plast Surg 2004;53:278–81Google Scholar