Management of an acquired tracheoesophageal fistula with a fascial free flap

Abstract

Use of a fascial free flap to address a persistent acquired tracheoesophageal fistula, when an accompanying stenotic segment is not present, is a viable treatment option.

Management of acquired tracheoesophageal fistula with various clinical presentations

“…Benign fistulae may be of greater surgical interest because of their possible curative management. The nonmalignant etiologies include complications of mechanical ventilation [4,6], indwelling tracheal or esophageal stents [7,8], granulomatous mediastinal infections [9], trauma [10], iatrogenic injuries [5], and caustic ingestion [4]. The incidence of acquired TEF is lower in children, and most are caused by foreign body impaction [2,11].…”

“…Fistulae with larger defects and closer proximity to the carina or with associated long tracheal stenosis require a variety of different techniques for single-stage repair according to the literature. Segmental tracheal resection and anastomosis with direct esophageal closure [1,4,18], tracheal closure using an esophageal [18] or gastric antral patch [23], tracheal replacement with aortic homograft [24,25], and closure of the defects with soft tissue flaps [3,5] are among the more complicated procedures used for single-stage management. Some of the presenting findings on admission suggest a staged surgical approach to avoid fatal pulmonary complications and surgical failure.…”

“…Acquired TEF is a rare clinical entity, mostly caused by malignant conditions in adults [5]. Benign fistulae may be of greater surgical interest because of their possible curative management.…”

Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer

“…Thus, the importance of endoscopic guidance during PDT has been emphasized [1,7,12,14]. Serious complications after PDT include extensive longitudinal posterior-lateral tracheal laceration [18] or rupture to the posterior wall of the trachea [20], near total transection of the trachea [16], tracheoesophageal fistula [24], pneumothorax or airway obstruction [5], massive subcutaneous emphysema [15], tracheoinnominate fistula [4], and erosion of the bracheocephalic trunk [13].…”

Sternohyoid muscle flap interposition in the treatment of an acquired tracheoesophageal fistula

“…2,3 Moreover, the concomitant presence of a rigid nasogastric tube is deemed to increase the risk of ischemia and necrosis of both tracheal and esophageal walls. [4][5][6][7] Nowadays, despite the extensive use of highvolume low pressure cuffs has reduced the incidence of tracheoesophageal fistulas, prolonged intubation is still the most important cause of acquired fistulas. 3,[8][9][10] Because spontaneous closure is rare and communication between trachea and esophagus is a life-threatening condition consequent to tracheo-bronchial contamination and aspiration pneumonia, surgical closure of the fistula is mandatory.…”