Nonoperative Treatment of a Tracheocutaneous Fistula in a Burn Patient

Abstract

Tracheocutaneous fistula (TCF) is a complication occurring after decannulation of a long-term tracheostomy and can lead to significant morbidity. We describe a case of a TCF in a burn patient treated without surgery. No previous cases have been described. A 65-year-old woman presented with symptomatic hypertrophic burn scar contractures of the anterior neck 6 months after undergoing excision and grafting of full-thickness burns to the neck and chest. She had a history of tracheostomy placement at the time of burn. Two months later, she was decannulated with no evidence of TCF. She subsequently underwent excision of hypertrophic burn scar contractures of the neck with placement of bilayer wound matrix followed by split-thickness skin grafting. Postoperatively she was noted to have a TCF with subgraft emphysema and difficulty in phonation and respiration. With local wound care, the TCF closed spontaneously and a new skin graft was placed uneventfully. At 18 months postoperatively, fistula closure was maintained with good functional and aesthetic outcome. Conservative management of an iatrogenic TCF in a burn patient may result in adequate soft-tissue coverage and allow for subsequent successful skin grafting. This method affords minimal morbidity to the patient and is a viable alternative to more elaborate flap reconstruction.

Persistent Tracheo-cutaneous Fistula: A Case Report

“…Al-Samri et al (4) reported that upper airway obstruction due to subglottic stenosis and craniofacial syndromes were the 2 most common indications in 15 (21%) patients each, and TCF was seen in 37%. Huber et al (15) have also reported a case of a patient with burns whose TCF healed with local wound care and without surgery. While granulomatous infection is a known predisposing factor, cases with pulmonary tuberculosis leading to failure of spontaneous closure of a tracheostomy have not been widely reported in the literature.…”