Tracheocutaneous fistula ‐ A surgical challenge

Abstract

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Closure of a persistent tracheal stoma

“…Tracheal stomas usually close without intervention after decannulation. E5 However, if squamous epithelium from the skin migrates along the stoma, toward the trachea, a persistent, nonhealing stoma may form. 2 , E6 Prolonged time in place, low nutritional status, and high-dose steroid use are risk factors for persistent stoma 2 , E7 ; 70% of tracheostomies in place longer than 16 weeks are associated with formation of a tracheocutaneous fistula.…”

“…There are multiple methods to close persistent stomas, 4 , E8 including a rhomboid flap and Z-plasty, 5 , E3 a hinged skin flap, E9 a turnover flap, E10 and a pectoralis major musculocutaneous flap. E5 There is no standard method. Choice of method depends on surgeon experience and the size and complexity of the defect.…”

Contralateral Pectoralis Flap for Repair of Spinal Hardware-Associated Fistula

“…The pectoralis muscle flap has a reliable blood supply from the thoracoacromial vessels and can provide a large amount of tissue. 6 Its utilization has been described numerous times in the literature for the purposes of reconstructive surgery of the head and neck. [6][7][8][9] Nevertheless, bilateral pectoralis flaps is an uncommon situation that in this case was encountered due to a unique constellation of circumstances.…”

“…6 Its utilization has been described numerous times in the literature for the purposes of reconstructive surgery of the head and neck. [6][7][8][9] Nevertheless, bilateral pectoralis flaps is an uncommon situation that in this case was encountered due to a unique constellation of circumstances. We think that the first pectoralis muscle flap failed because it did not fully cover the hardware, and was exposed to saliva and infection and revision inset that compromised the blood supply.…”