A Simple Closure Technic for Tracheoesophageal Puncture Failures

Abstract

Tracheosephageal puncture is the one of the most favorable methods, and widely used by physicians for voice reconstruction after total laryngectomy. Intractable leakages from the tracheosephageal punctures are the most common complication, and management of these fistulas is still troublesome for the patients and physicians. Local surgical sutures, rotational flaps, injections are reported previously, but in this report the authors aimed to mention on a very simple method with silicone septal button. Insertion of a temporary silicone septal button may be well tolerated by patients and can help to manage this complication easily on exact indications. The authors discussed indications and long-term results of this method with different patients.

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

“…9,[24][25][26]33,52 Ten studies reported the size of the puncture diameter. 8,26,29,37,39,40,43,44,47,49 Remarkably, tracheal wall closure, fistula excision, and esophageal wall closure with or without interposition of a dermal graft or fascia lata (FL), was the most common reconstructive technique when defects were of 15 mm or less. 8,29,44,47 Placement of a silicone septal button was proposed in patients with a TE defects of 15 to 20 mm, an intervention that was successful in five of the six patients reported in these series.…”

“…To our knowledge, no intestinal flaps were reported for the closure of TEPs, but Viñals Viñals et al implemented a gastroomental free flap performing the anastomosis beyond the radiated area in a patient with a previously failed reconstruc-tion using a muscle flap. 40 The stomach patch was customized to the esophageal defect without the additional bulk of muscular or fasciocutaneous flaps, and the omentum was placed around the tracheostomy and interposed between trachea and esophagus creating a three-layer reconstruction. 40 The patient was able to receive a new TEP and voice prosthesis 2 years after reconstruction.…”

“…40 The stomach patch was customized to the esophageal defect without the additional bulk of muscular or fasciocutaneous flaps, and the omentum was placed around the tracheostomy and interposed between trachea and esophagus creating a three-layer reconstruction. 40 The patient was able to receive a new TEP and voice prosthesis 2 years after reconstruction. 40 In the experience of senior authors (H.C.C.…”

“…Wreesmann et al used a bilaminar flee flap in a defect of 40 mm; Dewey et al employed a bipaddled FFF, with or without a pectoralis major flap, in defects with an average diameter of 32.5 mm; and Viñals Viñals et al a gastro-omental free flap in a defect of 50 mm, the greatest in this review. 26,37,40 From the aforementioned patients treated with a free flap, all had a successful TEP closure (►Table 3). 26,37,40…”

“…26,37,40 From the aforementioned patients treated with a free flap, all had a successful TEP closure (►Table 3). 26,37,40…”