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Review
. 2015 Nov 1:9:251.
doi: 10.1186/s13256-015-0728-z.

The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature

Allison K Royer  1 , Mark C Royer  2 , Jonathan Y Ting  3 , Edward C Weisberger  4 , Michael G Moore  5
Affiliations
Review

The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature

Allison K Royer et al. J Med Case Rep. .

Abstract

Introduction: The closure of complex tracheocutaneous fistulae is a surgical challenge. We describe a staged approach for management of a patient with a large tracheocutaneous fistula in the setting of prior surgery and local radiation therapy.

Case presentation: A 66-year-old Caucasian man who had undergone prior surgery and radiation therapy to the lower neck presented to our hospital for treatment of a large tracheocutaneous fistula that had developed with an adjacent area of tracheal stenosis. A prefabricated composite graft made up of an inner mucosal lining (buccal mucosa), a central cartilage structure (conchal cartilage), and external skin lining was constructed on the patient's distal volar forearm and subsequently harvested in a staged fashion. This graft was transferred as a free flap and successfully used to close the patient's defect following revascularization. Sixty months after surgery, the patient had no airway compromise or new dysphonia.

Conclusions: The use of a prefabricated mucosally lined composite graft can allow for successful closure of large tracheocutaneous fistulae, even in the setting of prior radiation therapy.

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Figures

Fig. 1
Fig. 1
a The patient’s tracheocutaneous fistula defect included the entire anterior tracheal wall and a portion of the bilateral sidewalls. b A bronchoscopic view shows the tracheocutaneous fistula with an endotracheal tube passed through it. Proximal tracheal stenosis is evident
Fig. 2
Fig. 2
a The conchal cartilage covered with buccal mucosa and implanted in the radial forearm is shown before the start of stage 3. b The radial forearm free flap with the mucosa-lined cartilage graft and skin paddle following harvest during stage 3
Fig. 3
Fig. 3
The radial forearm free flap was inset, and the radial artery and cephalic veins were anastomosed to the right superior thyroid artery and external jugular vein, respectively. a The mucosa-lined cartilage was positioned over the tracheal defect and secured. b The subcutaneous tissue and skin of the radial forearm free flap served as additional tissue support in final wound closure. Drains were placed in the neck
See this image and copyright information in PMC

References

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