A persistent tracheocutaneous fistula closed with two hinged skin flaps and rib cartilage interpositional grafting
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Persistent tracheal fistula after tracheostomy decannulation is a recognized sequel to long-term tracheostomy use, causing important morbidity including difficult to vocalization and control of air secretions, recurrent pulmonary infections, and cosmetic and social problems. Herein, we reported a new method for closure of persistent tracheocutaneous fistula with rib cartilages. Compared to other techniques previously reported, the variations of our strategy were the use of temporary metal-covered tracheal stent and the hinged turnover skin bi-flaps reinforced with rib cartilage grafts. Rib cartilages were useful in order to reconstruct the trachea and prevent stenosis. Since it become difficult to obtain the maintenance of the trachea stability until healing of suture was well established, a covered metallic stent was also inserted to avoid flap collapse. The stent was removed 3 months later. Six months follow-up showed normal tracheal patency.
KeywordsTracheocutaneous fistula Rib cartilage graft Skin flap Reconstruction Surgery
Conflict of interest
The authors disclose no conflict of interest and funding for the present paper.
Video 1. The edited video reported the most important steps of operation as the incision and dissection of fistula, the preparation of two hinged turnover skin bi-flaps, their reinforcement with cartilage grafts, the placement of tracheal stent, the coverage of tracheal defect, and the result at six months follow-up. During operation the patient was ventilated using jet ventilation. (M4V 38733 kb)