Skip to main content Accessibility help
×
Home

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

  • N Mundi (a1), K B Patel (a1), D H Yeh (a1) and A C Nichols (a1)

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.

Copyright

Corresponding author

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

Footnotes

Hide All

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

Footnotes

References

Hide All
1White, AK, Smitheringale, AJ. Treatment of tracheocutaneous fistulae in children. J Otolaryngol 1989;18:4952
2Joseph, HT, Jani, P, Preece, JM, Bailey, CM, Evans, JN. Paediatric tracheostomy: persistent tracheo-cutaneous fistula following decannulation. Int J Pediatr Otorhinolaryngol 1991;22:231–6
3Mahadevan, M, Barber, C, Salkeld, L, Douglas, G, Mills, N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007;71:1829–35
4Tasca, RA, Clarke, RW. Tracheocutaneous fistula following paediatric tracheostomy--a 14-year experience at Alder Hey Children's Hospital. Int J Pediatr Otorhinolaryngol 2010;74:711–12
5Rob, CG, Bateman, GH. Reconstruction of the trachea and cervical oesophagus; preliminary report. Br J Surg 1949;37:202–5
6Grillo, HC. Tracheal replacement: a critical review. Ann Thorac Surg 2002;73:19952004
7Jackson, C, Babcock, W. Plastic closure of tracheocutaneous fistula. Surg Clin North Am 1934;14:199221
8Drezner, DA, Cantrell, H. Surgical management of tracheocutaneous fistula. Ear Nose Throat J 1998;77:534–7
9Fujiwara, T, Nishino, K, Numajiri, T. Tracheal reconstruction with a prefabricated and double-folded radial forearm free flap. J Plast Recon Aesth Surg 2009;62:790–4
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;33:7984
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;9:251
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;4:170–4
13Teng, MS, Malkin, BD, Urken, ML. Prefabricated composite free flaps for tracheal reconstruction: a new technique. Ann Otol Rhinol Laryngol 2005;114:822–6
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;53:278–81

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed