A simple closure technique for reversal of tracheoesophageal puncture

Reconstruction of expanding tracheoesophageal fistulae in post‐radiation therapy patients who undergo total laryngectomy with a bipaddled radial forearm free flap: Report of 8 cases

“…Several alternative approaches to our technique have been documented in the literature in attempts to overcome an enlarged fistula complication . Frequently, a nonsurgical approach is attempted before surgery.…”

“…Nonsurgical approaches include replacement of the prosthetic device with a prosthesis of larger diameter, enlargement of the prosthesis' flanges and reduction of the shaft length, injections, and insertion of a salivary bypass tube . However, a variety of complications can result from these treatment methods, such as progressive dilation of the fistula tract, persistent leakage from the fistula, mucosal necrosis, irritation, and granulation tissue formation . Another effective nonsurgical method is the placement of a large silicone septal button, inserted through the TEF, after the removal of the salivary bypass tube .…”

“…Several authors have suggested surgical techniques without the use of a flap . Geyer et al proposed a conventional 3‐layer closure; Hosal and Myers demonstrated a multilayered closure of the esophageal mucosa paired with direct closure of the tracheal wall. These authors argue that closure with bulky flaps may diminish the lumen of the trachea or the esophagus.…”

“…In the past 6 decades, several approaches for TEF closure have been reported . In 2010, Urken described a bipaddled radial forearm free flap (RFFF) approach for complete closure of the TEF.…”

Total Closure of Enlarged Tracheoesophageal Puncture with Septal Button: Long-Term Results

“…Suturing of esophageal and tracheal mucosa separately after dissecting the TE space and dividing the TE tract as well as inset of well-vascularized tissue and muscular flaps including sternohyoid, sternocleidomastoid, intercostal, latissimus dorsi, pectoralis major, or radial free flaps between the trachea and esophagus constitute the mainstay of the surgical repair of enlarged TEP [7,8]. However, surgery for closure of enlarged TEP is challenging due to the poor healing capacity of the radiated tissue in many patients [9]. …”