Management of Tracheocutaneous Fistula

Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: A case report

“…[1][2][3][4][5][6][7][8][9] These include multiple layered primary closure with partial fistulectomy, 3 bipedicle delayed flap closure with primary inversion of the edges of the fistula (fistulectomy with healing by secondary intention), 1 closure by transplantation of an ear cartilage graft with muscle and fasciocutaneous flaps, 4 and elevation and inward rotation of the epithelial lining of the tracheocutaneous fistula as a marginal flap, using a hinged turnover flap, with an additional V-Y advancement flap. 2,[5][6][7][8][9] It has been reported that primary closure with excision of the fistula tract down to the level of the trachea may result in tracheocele, pneumopericardium, pneumothorax, and pneumomediastinum. 1,2,[10][11][12] Closure with a turnover flap of skin and fibroadipose tissue means that the defect in the tracheal lumen is covered by the outer surface of the cutaneous flap.…”

“…This minimizes the suturing required, and results in fewer problems with insufficiency of the repair. [5][6][7][8][9] The epithelial layer of the hinged flap will eventually be replaced with a mucosal layer. 6 Even though with invagination of two hinged turnover flaps into the fistula, using multiple layered sutures, it is possible to avoid narrowing the tracheal lumen.…”

“…9 Furthermore, a strap muscle flap was utilized to reinforce the fistula closure. 3,5 By using an advanced skin flap or a skin flap by subcutaneous Z-plasty with which to cover the repair site, the suturing lines of the tracheal defect and the suturing lines of the skin defect are not in parallel, helping to prevent recurrence of the fistula. When the orfice of the tracheocutaneous fistula is large or the sacrring around the tracheocutaneous fistula is strong, Z-plasty may be more advantage.…”

Tracheocutaneous Fistula Closure in the Pediatric Population: Should Secondary Closure Be the Standard of Care?

“…In addition, the rates of complication of the 2 methods in our series were similar, and no serious complications were encountered in either group during this study period, underscoring the rarity of serious complications from this procedure regardless of method. In light of equal efficacy, the only (1); other revision surgery included scar revision (11), endoscopic removal of granuloma (2), and tracheoplasty with graft to alleviate stenosis (1).…”

“…10 Many variations of primary closure have been developed and claim to reduce risks while maintaining cosmetic benefit and convenience; however, large and long-term studies of such methods are absent. [11][12][13][14][15][16] We have previously compared the 2 methods of TCF closure at our institution and found no significant differences in risks or efficacy between primary closure and secondary intention. 9 Shortly after this study was published, we experienced 2 serious complications using the primary closure method.…”