Successful repair using thymus pedicle flap for tracheoesophageal fistula: a case report

Matsunaga, Tomoyuki; Shishido, Yuji; Amisaki, Masataka; Kono, Yusuke; Murakami, Yuki; Kuroda, Hirohiko; Osaki, Tomohiro; Sakamoto, Teruhisa; Honjo, Soichiro; Ashida, Keigo; Saito, Hiroaki; Fujiwara, Yoshiyuki

doi:10.1186/s40792-018-0458-8

Cited by 9 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there are some disadvantages to using the thymus flap. As the thymus sometimes presents an atrophied fibrofatty tissue and has less volume for patch reinforcement in adulthood (12), preoperative CT evaluation of thymus volume is recommended. Interestingly, most patients have a sufficient volume of thymus flap to wrap the anastomosis clinically, despite a possible negative CT appearance of sufficient thymus gland, and no anastomotic complications were observed in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series

Wang¹,

Dong²,

Zhuang³

et al. 2022

Transl Lung Cancer Res

View full text Add to dashboard Cite

Background: Anastomosis management is the main challenge of airway resection and reconstruction, and postoperative anastomotic complications, including ischemia, stenosis, dehiscence, and separation may lead to severe outcomes and a poor prognosis. The anastomotic buttress is vital in airway reconstruction, but the selection of surgical buttress and reinforcement remains controversial. We aimed to demonstrate and evaluate the buttress options of anastomosis, including their preoperative characteristics, the intraoperative process, and the incidence of postoperative complications to help address the controversy regarding anastomosis management.Methods: This retrospective study was conducted at a single institution. Patients who underwent airway reconstruction with anastomotic wrapping from Jan. 2019 to Sep. 2021 were enrolled in this study and preoperative characteristics and operational features were collected. All patients were carefully followed up by telephone and outpatient. Their postoperative complications and postoperative status after 6 months were recorded. The surgical procedures and clinical characteristics of the buttress options of anastomosis were assessed.Results: A total of 62 patients undergoing either cervical tracheal, thoracic tracheal, carinal, or secondary carinal and main bronchus resection and reconstruction were evaluated. The anastomotic buttress used included mediastinal pleural flap (24/62, 38.7%), anterior cervical muscle (14/62, 22.6%), sternocleidomastoid (2/62, 3.2%), thymus flap (12/62, 19.4%), intercostal muscle flap (2/62, 3.2%), biological patch (2/62, 3.2%), prepericardial fat (1/62, 1.6%), thyroid gland (1/62, 1.6%), pectoralis major flap (2/62, 3.2%), and omental flap (2/62, 3.2%). All procedures produced satisfactory results without short-term anastomotic complications. A follow-up for 6 months was conducted and all patients were alive postoperatively. Tracheomalacia stenosis postoperatively occurred in 3 patients and they were subsequently treated with an endotracheal stent. One patient had tumor recurrence 3 months after surgery and received adjuvant chemotherapy. Utilization of buttress VariablesAnastomotic wrapping was defined as the overlaying of different tissue structures or biomaterials on the Conclusions: Various anastomotic wrapping materials are used in airway reconstruction. Different utilizations of buttress are selected according to the anatomic characteristics and the reconstruction method used. This study indicated that appropriate surgical buttresses for wrapping anastomoses are legitimate alternatives to reduce the risk of anastomotic complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series

Wang¹,

Dong²,

Zhuang³

et al. 2022

Transl Lung Cancer Res

View full text Add to dashboard Cite

show abstract

“…Other options, like a thymus pedicle flap, pleural flap, diaphragmatic flap and azygous flap, have been described for lower fistulae, but require sternotomy. 5 Knowledge of angiosomes and perforator anatomy, combined with advances in microvascular surgery, have enabled the recruitment of thin, pliable tissue from the surrounding trunk, with minimal donor site morbidity. 6 Vesely et al, in 2007, described in detail the anatomy and applications of the internal mammary artery perforator flap after cadaver studies.…”

Section: Introductionmentioning

confidence: 99%

“…Other options, like a thymus pedicle flap, pleural flap, diaphragmatic flap and azygous flap, have been described for lower fistulae, but require sternotomy. 5…”

Section: Introductionmentioning

confidence: 99%

Internal mammary artery perforator flap in the management of tracheoesophageal fistulae

Kaur,

Biswas

2024

J. Laryngol. Otol.

View full text Add to dashboard Cite

Background A pathological communication between the trachea and oesophagus – a tracheoesophageal fistula – may be congenital or acquired, benign or malignant, necessitating a multidisciplinary approach. Conservative attempts at closure of this abnormal connection are ineffective; the interposition of healthy vascular tissue offers the least chance of recurrence. Methods Outcomes of an islanded fasciocutaneous internal mammary artery perforator flap applied for tracheoesophageal fistula management were assessed in four radiated patients with laryngeal carcinoma using retrospective records. Results Four male patients, with an average age of 60.75 years, underwent tracheoesophageal fistula closure between September 2017 and February 2021. A left-sided second internal mammary artery perforator flap was used in all cases, with an average dimension of 10.5 × 4.5 cm. There were no complications of tracheoesophageal leak, flap issues or donor site morbidity on follow up. Conclusion Recent advances in angiosomal territory mapping and microvascular dissection techniques, combined with an understanding of tracheoesophageal fistula pathology, have changed management perspectives in these difficult-to-treat patients.

show abstract

“…Due to the lack of effective treatment for TEF fistulas, patients often experience respiratory failure combined with other serious complications, which significantly reduces their quality of life and increases their disability fatality rate [ 4 ]. At present, there is no standard treatment for TEF; although there have been cases of thoracoscopic repair of TEF involving muscle, pericardial or thymic valves [ 5 ], most TEF patients cannot tolerate surgery due to malnutrition combined with pulmonary complications.…”

Section: Introductionmentioning

confidence: 99%

Airway and anesthesia management in tracheoesophageal fistula closure implantation: a single-centre retrospective study

Dechong,

He,

Jigang

et al. 2024

J Cardiothorac Surg

View full text Add to dashboard Cite

Objective To review and analyze the airway and anesthesia management methods for patients who underwent endoscopic closure of tracheoesophageal fistula (TEF) and to summarize the experience of intraoperative airway management. Method We searched the anesthesia information system of the First Affiliated Hospital of Nanjing Medical University for anesthesia cases of TEF from July 2020 to July 2023 and obtained a total of 34 anesthesia records for endoscopic TEF occlusion. The intraoperative airway management methods and vital signs were recorded, and the patients’ disease course and follow-up records were analyzed and summarized. Results The airway management strategies used for TEF occlusion patients included nasal catheter oxygen (NCO, n = 5), high-flow nasal cannula oxygen therapy (HFNC, n = 4) and tracheal intubation (TI, n = 25). The patients who underwent tracheal intubation with an inner diameter of 5.5 mm had stable hemodynamics and oxygenation status during surgery, while intravenous anesthesia without intubation could not effectively inhibit the stress response caused by occluder implantation, which could easily cause hemodynamic fluctuations, hypoxemia, and carbon dioxide accumulation. Compared with those in the TI group, the NCO group and the HFNC group had significantly longer surgical times, and the satisfaction score of the endoscopists was significantly lower. In addition, two patients in the NCO group experienced postoperative hypoxemia. Conclusion During the anesthesia process for TEF occlusions, a tracheal catheter with an inner diameter of 5.5 mm can provide a safe and effective airway management method.

show abstract

Successful repair using thymus pedicle flap for tracheoesophageal fistula: a case report

Cited by 9 publications

References 13 publications

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series

Internal mammary artery perforator flap in the management of tracheoesophageal fistulae

Airway and anesthesia management in tracheoesophageal fistula closure implantation: a single-centre retrospective study

Contact Info

Product

Resources

About