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

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

J Med Case Rep. 2015;9(1):251

Authors: Royer AK, Royer MC, Ting JY, Weisberger EC, Moore MG

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.

PMID: 26520064 [PubMed - as supplied by publisher]

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