Closing an Intractable Tracheoesophageal Fistula Caused by a Tracheoesophageal Shunt Using a Myocutaneous Flap and a Hinged Flap With Skin Graft in a Two-Step Procedure.
free jejunal reconstruction
high-frequency jet ventilation
prelaminated hinged flap
tracheoesophageal fistula
tracheoesophageal shunt
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
accepted:
25
06
2021
entrez:
29
7
2021
pubmed:
30
7
2021
medline:
30
7
2021
Statut:
epublish
Résumé
Total laryngectomy involves removal of the vocal cords resulting in the loss of vocal function. After laryngectomy, the patient's vocal function can be restored in several ways, including the insertion of a tracheoesophageal (TE) shunt. A TE shunt is considered an effective means of restoring speech due to its high efficacy, low requirement for training, and no need for any equipment while speaking. However, complications such as saliva inflow into the trachea, caused by the widening of the shunt opening, have also been reported. Moreover, the optimal treatment for an enlarged fistula has not yet been established. A fistula may also form at sites of hypopharyngeal reconstruction with free jejunal transplantation. Following its formation, the influx of saliva, infections, and pressure exerted by the act of swallowing make a fistula resistant to closure, and most patients require closure surgery using myocutaneous flaps. We encountered a case where an intractable TE fistula formed due to a TE shunt after the patient underwent total pharyngolaryngeal resection for hypopharyngeal cancer and hypopharyngeal reconstruction with a free jejunum flap. Since the optimal method for the TE fistula closure remains uncertain, we attempted to close the fistula according to the fistula closure of the free jejunal transplantation. Failure to close a TE fistula using a myocutaneous flap necessitates a re-closure procedure. However, because the surgical field around the trachea can be limited in such patients, creating an additional myocutaneous flap may not be feasible. In addition to the myocutaneous flap, ventilation control using a conventional intubation tube may further narrow the surgical field during the re-closure surgery. Based on our experience and existing literature, in this article, we summarize several ways of managing TE fistula when the surgical field around the trachea is limited.
Identifiants
pubmed: 34322353
doi: 10.7759/cureus.15913
pmc: PMC8310611
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e15913Informations de copyright
Copyright © 2021, Morimatsu et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
ORL J Otorhinolaryngol Relat Spec. 2015;77(5):268-72
pubmed: 26315825
Head Neck. 2001 Mar;23(3):214-6
pubmed: 11428451
J R Soc Med. 1999 Jun;92(6):299-302
pubmed: 10472284
Laryngoscope. 1990 Nov;100(11):1202-7
pubmed: 2233085
Microsurgery. 1994;15(9):618-23
pubmed: 7845188
Arch Otorhinolaryngol. 1978 Mar 3;220(1-2):149-52
pubmed: 580572
Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Apr;130(2):49-53
pubmed: 23228654
Plast Reconstr Surg Glob Open. 2020 Feb 26;8(2):e2663
pubmed: 32309103
Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e340-e350
pubmed: 19952702
Laryngoscope. 1989 Jun;99(6 Pt 1):614-7
pubmed: 2725156
Laryngoscope. 2007 Nov;117(11):1943-51
pubmed: 17828044
Am J Surg. 1987 Oct;154(4):394-8
pubmed: 2444122
Acta Otorhinolaryngol Ital. 2019 Jun;39(3):162-168
pubmed: 31131835
Laryngoscope. 1997 Apr;107(4):527-30
pubmed: 9111385
Plast Reconstr Surg. 2006 Mar;117(3):968-74
pubmed: 16525294
Head Neck. 2009 Jun;31(6):838-42
pubmed: 19073008
Eur Arch Otorhinolaryngol. 2004 Aug;261(7):381-5
pubmed: 14576949