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Buncke M, Andersen P, Connelly C, Clayburgh D. Novel stapler-assisted technique for closure of persistent tracheoesophageal puncture fistula. Head Neck 2023; 45:288-293. [PMID: 36345612 DOI: 10.1002/hed.27236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Tracheoesophageal puncture (TEP) is a reliable method to restore voice and is an important part of voice rehabilitation following laryngectomy. However, complications following this procedure, including peri-prosthetic leakage and resulting aspiration pneumonia, may necessitate surgical closure. In this study, we present an effective and reliable method for TEP closure using a stapler-assisted technique. Case series study for patients who underwent stapler-assisted TEP closure reviewed from 2017 to 2021. All five patients had successful closure of their TEP tract without further leakage. No postoperative bleeding, wound infection, or esophageal stenosis occurred. One patient had postoperative stomal stenosis. The stapler-assisted technique for TEP closure is easy, quick, and effective. The reliability and quick return to oral intake post-operatively make it a preferable option over previous techniques.
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Affiliation(s)
- Michelle Buncke
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Andersen
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher Connelly
- Division of Abdominal Organ Transplantation, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Clayburgh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.,Operative Care Division, Portland Veterans Affairs Health Care System, Portland, Oregon, USA
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2
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Escandón JM, Mohammad A, Mathews S, Bustos VP, Santamaría E, Ciudad P, Chen HC, Langstein HN, Manrique OJ. Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis. Arch Plast Surg 2022; 49:617-632. [PMID: 36159387 PMCID: PMC9507600 DOI: 10.1055/s-0042-1756347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.
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Affiliation(s)
- Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New York
| | - Arbab Mohammad
- Department of Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, Tamil Nadu, India
| | - Saumya Mathews
- Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Eric Santamaría
- Department of Plastic and Reconstructive Surgery, National Cancer Institute, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico
| | - Pedro Ciudad
- Reconstructive and Burn Surgery Department, Arzobispo Loayza National Hospital, Lima, Peru.,Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Howard N Langstein
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New York
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New York
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3
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Holmes MJV, George A. Technical note: the use of a silicone prosthesis for the closure of a tracheoesophageal fistula. Clin Otolaryngol 2022; 47:483-485. [PMID: 35147287 DOI: 10.1111/coa.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/10/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew J V Holmes
- Department of Otolaryngology, University Hospitals North Midlands, Stoke-on- Trent, UK
| | - Ajith George
- Department of Otolaryngology, University Hospitals North Midlands, Stoke-on- Trent, UK
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Kremer T, Gazyakan E, Maurer JT, Ott K, Gerken A, Schmittner M, Ronellenfitsch U, Kneser U, Nowak K. Intra- and Extrathoracic Malignant Tracheoesophageal Fistula-A Differentiated Reconstructive Algorithm. Cancers (Basel) 2021; 13:cancers13174329. [PMID: 34503134 PMCID: PMC8430587 DOI: 10.3390/cancers13174329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tracheoesophageal fistulae (TEF) after oncologic resections and multimodal treatment are life-threatening and surgically challenging. Radiation and prior procedures hamper wound healing and lead to high complication rates. We present an interdisciplinary algorithm for the treatment of TEF derived from the therapy of consecutive patients. PATIENTS AND METHODS 18 patients (3 females, 15 males) treated for TEF from January 2015 to July 2017 were included. Two patients were treated palliatively, whereas reconstructions were attempted in 16 cases undergoing 24 procedures. Discontinuity resection and secondary gastric pull-up were performed in two patients. Pedicled reconstructions were pectoralis major (n = 2), sternocleidomastoid muscle (n = 2), latissimus dorsi (n = 1) or intercostal muscle (ICM, n = 7) flaps. Free flaps were anterolateral thigh (ALT, n = 4), combined anterolateral thigh/anteromedial thigh (ALT/AMT, n = 1), jejunum (n = 3) or combined ALT-jejunum flaps (n = 2). RESULTS Regarding all 18 patients, 11 of 16 reconstructive attempts were primarily successful (61%), whereas long-term success after multiple procedures was possible in 83% (n = 15). The 30-day survival was 89%. Derived from the experience, patients were divided into three subgroups (extrathoracic, cervicothoracic, intrathroracic TEF) and a treatment algorithm was developed. Primary reconstructions for extra- and cervicothoracic TEF were pedicled flaps, whereas free flaps were used in recurrent or persistent cases. Pedicled ICM flaps were mostly used for intrathoracic TEF. CONCLUSION TEF after multimodal tumor treatment require concerted interdisciplinary efforts for successful reconstruction. We describe a differentiated reconstructive approach including multiple reconstructive techniques from pedicled to chimeric ALT/jejunum flaps. Hereby, successful reconstructions are mostly possible. However, disease and patient-specific morbidity has to be anticipated and requires further interdisciplinary management.
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Affiliation(s)
- Thomas Kremer
- Burn Center, Department of Plastic and Hand Surgery, St. Georg Clinic, 04129 Leipzig, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University Heidelberg, 67071 Ludwigshafen, Germany; (E.G.); (U.K.)
- Correspondence: ; Tel.: +49-341-9092555; Fax: +49-341-9092291
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University Heidelberg, 67071 Ludwigshafen, Germany; (E.G.); (U.K.)
| | - Joachim T. Maurer
- Mannheim University Medical Center, Department of Ear, Nose and Throat Surgery, 68167 Mannheim, Germany;
| | - Katja Ott
- Department of General, Vascular and Thoracic Surgery, RoMed Klinikum, 83022 Rosenheim, Germany; (K.O.); (K.N.)
| | - Andreas Gerken
- Mannheim University Medical Center, Department of Surgery, 68167 Mannheim, Germany; (A.G.); (U.R.)
| | - Marc Schmittner
- Mannheim University Medical Center, Department of Anesthesia and Critical Care Medicine, 68167 Mannheim, Germany;
| | - Ulrich Ronellenfitsch
- Mannheim University Medical Center, Department of Surgery, 68167 Mannheim, Germany; (A.G.); (U.R.)
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, University Medical Center Halle (Saale), 06120 Halle, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University Heidelberg, 67071 Ludwigshafen, Germany; (E.G.); (U.K.)
| | - Kai Nowak
- Department of General, Vascular and Thoracic Surgery, RoMed Klinikum, 83022 Rosenheim, Germany; (K.O.); (K.N.)
- Mannheim University Medical Center, Department of Surgery, 68167 Mannheim, Germany; (A.G.); (U.R.)
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Morimatsu Y, Yonezawa K, Matsui H, Iwae S, Sakakibara S. Closing an Intractable Tracheoesophageal Fistula Caused by a Tracheoesophageal Shunt Using a Myocutaneous Flap and a Hinged Flap With Skin Graft in a Two-Step Procedure. Cureus 2021; 13:e15913. [PMID: 34322353 PMCID: PMC8310611 DOI: 10.7759/cureus.15913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Total laryngectomy involves removal of the vocal cords resulting in the loss of vocal function. After laryngectomy, the patient's vocal function can be restored in several ways, including the insertion of a tracheoesophageal (TE) shunt. A TE shunt is considered an effective means of restoring speech due to its high efficacy, low requirement for training, and no need for any equipment while speaking. However, complications such as saliva inflow into the trachea, caused by the widening of the shunt opening, have also been reported. Moreover, the optimal treatment for an enlarged fistula has not yet been established. A fistula may also form at sites of hypopharyngeal reconstruction with free jejunal transplantation. Following its formation, the influx of saliva, infections, and pressure exerted by the act of swallowing make a fistula resistant to closure, and most patients require closure surgery using myocutaneous flaps. We encountered a case where an intractable TE fistula formed due to a TE shunt after the patient underwent total pharyngolaryngeal resection for hypopharyngeal cancer and hypopharyngeal reconstruction with a free jejunum flap. Since the optimal method for the TE fistula closure remains uncertain, we attempted to close the fistula according to the fistula closure of the free jejunal transplantation. Failure to close a TE fistula using a myocutaneous flap necessitates a re-closure procedure. However, because the surgical field around the trachea can be limited in such patients, creating an additional myocutaneous flap may not be feasible. In addition to the myocutaneous flap, ventilation control using a conventional intubation tube may further narrow the surgical field during the re-closure surgery. Based on our experience and existing literature, in this article, we summarize several ways of managing TE fistula when the surgical field around the trachea is limited.
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Affiliation(s)
| | - Koichiro Yonezawa
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, JPN.,Department of Otolaryngology, Nishikawa ENT Clinic, Higashi Osaka, JPN
| | - Hidetoshi Matsui
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, JPN
| | - Shigemichi Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, JPN
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN.,Department of Plastic Surgery, Hyogo Cancer Center, Akashi, JPN
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6
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Yavuz H, Vural O. Tracheoesophageal puncture closure with annular mucosal flap. Head Neck 2021; 43:1705-1710. [PMID: 33544436 DOI: 10.1002/hed.26631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To present an effective and easily applicable method for tracheoesophageal puncture (TEP) closure by using a localized annular flap instead of bulky and distant flaps. METHODS The medical records of patients who underwent TEP closure surgery with the annular mucosal flap technique between July 2012 and August 2018 were retrospectively reviewed. Fistula size, indication for closure, duration of surgery, radiotherapy status, and surgery results were analyzed. RESULTS We have used our technique in nine patients. No postoperative bleeding, wound infection, esophageal stenosis, and tracheostoma stenosis occurred. In all these patients except one, successful closure was achieved. None of the patients had a recurrence of the TEP. CONCLUSION The annular mucosal flap technique for TEP closure is easy and quick to apply. The patient's oral feeding at the sixth hour after procedure without using a nasogastric tube makes the technique preferable as a priority.
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Affiliation(s)
- Haluk Yavuz
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Omer Vural
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
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Mammana M, Comacchio GM, Schiavon M, Zuin A, Natale G, Faccioli E, Fortarezza F, Pezzuto F, Rea F. Repair of Adult Benign Tracheoesophageal Fistulae With Absorbable Patches: Single-Center Experience. Ann Thorac Surg 2019; 109:1086-1094. [PMID: 31760058 DOI: 10.1016/j.athoracsur.2019.09.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This group previously reported on the repair of a wide tracheoesophageal fistula with a bioabsorbable patch. The current study describes a consecutive series of patients operated on using the same technique. METHODS Data of patients undergoing surgical closure of tracheoesophageal fistula at a single center from 2011 to 2018 were extracted and analyzed. RESULTS An absorbable patch was used in 8 of 23 patients (34.8%) operated on for tracheoesophageal fistula during the study period. Causes of the fistulae included postintubation injury (n = 6), mediastinal radiotherapy (n = 1), and a complication of lung resection (n = 1). The median fistula size was 27.5 mm (range, 15 to 45 mm). In 3 patients, the surgical approach was through cervicotomy and in 5 it was through right thoracotomy. Prosthetic materials consisted of Gore Bio-A (W.L. Gore & Associates, Inc, Newark, DE) tissue reinforcement in 6 patients and polyglactin 910 knitted mesh in 2 patients. In every case, the prosthesis was covered with a pedicled muscle flap. The esophageal defect was treated by primary closure in 7 patients and by esophageal exclusion in 1. Fistula recurrence and postoperative death occurred in 1 patient (12.5%), whereas 7 patients experienced postoperative complications (87.5%). Five patients resumed oral intake, and 3 breathed without a tracheal appliance. Compared with the other patients, in those who underwent repair of their fistula using a prosthesis, the median size of the airway defect was larger, morbidity was greater, and the rate of resumption of oral intake was lower. CONCLUSIONS Repair of tracheoesophageal fistulae with synthetic prostheses is feasible and may be effective in complex cases. Further research is needed to identify the ideal prosthetic material.
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Affiliation(s)
- Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni M Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Natale
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Fortarezza
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federica Pezzuto
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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8
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Gozen ED, Tevetoglu F, Eker C, Yener HM, Karaman E. A simple and effective method for closure of enlarged tracheoesophageal puncture in seven patients. Clin Otolaryngol 2019; 44:1224-1227. [PMID: 31286681 DOI: 10.1111/coa.13401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Emine Deniz Gozen
- Otorhinolaryngology Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Firat Tevetoglu
- Otorhinolaryngology Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Caglar Eker
- Otorhinolaryngology Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - H Murat Yener
- Otorhinolaryngology Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emin Karaman
- Otorhinolaryngology Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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9
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Fascia lata graft closure of an enlarged tracheoesophageal puncture (TEP) after laryngectomy/laryngopharyngectomy. Eur Arch Otorhinolaryngol 2019; 276:2355-2359. [DOI: 10.1007/s00405-019-05444-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/22/2019] [Indexed: 11/27/2022]
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10
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Abstract
A tracheoesophageal voice prosthesis is very effective for improving speech after total laryngectomy. Although it is generally a safe method, it may be necessary to close the tracheoesophageal fistula due to complications such as prosthesis-related cellulitis, granulation tissue formation, tracheoesophageal fistula necrosis, or salivary leakage around the prosthesis. Surgical and non-surgical methods for closure have been described. In this article, a method for closing the tracheoesophageal fistula with a butterfly cartilage graft is described. The butterfly cartilage technique is safe and efficient in terms of anatomical closure of the fistula. This study shows that the method can be easily applied, with low morbidity, using an auto-graft material with local anesthesia in an outpatient setting.
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11
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Using a Sternocleidomastoid Muscle Flap to Close an Iatrogenic Tracheoesophageal Fistula in a Patient With Advanced Laryngeal Cancer: A Case Report and Literature Review. Ann Plast Surg 2018; 82:S126-S129. [PMID: 30516563 DOI: 10.1097/sap.0000000000001718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An iatrogenic tracheoesophageal (TE) fistula is one possible complication after total laryngectomy with flap reconstruction. We used sternocleidomastoid (SCM) rotation flap to close a TE fistula. METHODS AND RESULTS A 69-year-old man with laryngeal cancer underwent total laryngectomy with radial forearm free flap reconstruction. A tracheostoma stenosis was noticed 7 months after the tracheostomy tube was removed. The patient underwent tracheostoma dilatation; the iatrogenic TE fistula was noticed 1 month later. We used SCM rotation flap to close the TE fistula. The postoperative course was uneventful. A barium esophagogram showed no leakage in the esophagus. CONCLUSIONS Tracheoesophageal fistula can be reconstructed with an SCM rotation flap. If the TE fistula is of a suitable size, this reconstructive strategy is effective and simple to close persistent TE fistula and avoid further airway complications.
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Erdim I, Sirin AA, Baykal B, Oghan F, Guvey A, Kayhan FT. Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings. Braz J Otorhinolaryngol 2016; 83:536-540. [PMID: 27472983 PMCID: PMC9444751 DOI: 10.1016/j.bjorl.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/05/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. Objective To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. Methods A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn’t be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. Results Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29 ± 6 months follow up. Conclusion Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.
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Affiliation(s)
- Ibrahim Erdim
- Bakirkoy Sadi Konuk Education and Research Hospital, Department of ORL, Istanbul, Turkey
| | - Ali Ahmet Sirin
- Bakirkoy Sadi Konuk Education and Research Hospital, Department of ORL, Istanbul, Turkey
| | - Bahadir Baykal
- Bakirkoy Sadi Konuk Education and Research Hospital, Department of ORL, Istanbul, Turkey
| | - Fatih Oghan
- Dumlupinar University, Faculty of Medicine, Department of ORL, Kutahya, Turkey.
| | - Ali Guvey
- Dumlupinar University, Faculty of Medicine, Department of ORL, Kutahya, Turkey
| | - Fatma Tulin Kayhan
- Bakirkoy Sadi Konuk Education and Research Hospital, Department of ORL, Istanbul, Turkey
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13
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Battistella L, Marulli G, Comacchio GM, Mammana M, Di Gregorio G, Rea F. Successful Treatment of a Recurrent Wide Tracheoesophageal Fistula With a Bioabsorbable Patch. Ann Thorac Surg 2016; 101:e173-5. [DOI: 10.1016/j.athoracsur.2015.11.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/10/2015] [Accepted: 11/13/2015] [Indexed: 10/21/2022]
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14
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Dewey EH, Castro JR, Mojica J, Lazarus CL, Su HK, Alpert EH, Dos Reis LL, Urken ML. Reconstruction of expanding tracheoesophageal fistulae in post-radiation therapy patients who undergo total laryngectomy with a bipaddled radial forearm free flap: Report of 8 cases. Head Neck 2015; 38 Suppl 1:E172-8. [PMID: 25545827 DOI: 10.1002/hed.23966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Our surgical approach describes a bipaddled radial forearm free flap (RFFF) for closure of chronic tracheoesophageal fistulae (TEF) in patients who underwent total laryngectomy. The desired functional results were achieved. METHODS Eight patients underwent the procedure. The surgical approach includes exposure and resection of the fistula tract, and a bipaddled RFFF transfer. Key surgical maneuvers include: circumferential dissection and mobilization of the trachea; partial sternal resection in select cases; inset of flap's distal paddle into the anterior esophageal wall; and inset of the proximal skin paddle to the posterior tracheal wall and cervical skin. RESULTS Successful reconstruction of all 8 cases was done to restore a normal diet and a widely patent tracheal opening. One patient developed a delayed esophageal stricture, which was successfully managed with home dilation. CONCLUSION Several TEF treatment approaches have been reported. Our 87.5% esophageal lumen preservation success rate, reestablishment of adequate airway, and uncomplicated postoperative courses demonstrates the reliability of this surgical approach. © 2015 Wiley Periodicals, Inc. Head Neck 38: E172-E178, 2016.
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Affiliation(s)
- Eliza H Dewey
- Thyroid Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Jerry R Castro
- Department of Head and Neck - Otolaryngology, Mount Sinai Beth Israel, New York, New York
| | - Jacqueline Mojica
- Department of Head and Neck - Otolaryngology, Mount Sinai Beth Israel, New York, New York
| | - Cathy L Lazarus
- Thyroid Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Henry K Su
- Thyroid Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Erin H Alpert
- Thyroid Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Laura L Dos Reis
- Thyroid Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Mark L Urken
- Department of Head and Neck - Otolaryngology, Mount Sinai Beth Israel, New York, New York
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15
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Post-radiation tracheoesophageal fistula following salvage laryngectomy: microsurgical repair using a “bi-laminar” lateral arm flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-1004-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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The development and treatment of periprosthetic leakage after prosthetic voice restoration: a literature review and personal experience. Part II: conservative and surgical management. Eur Arch Otorhinolaryngol 2014; 272:661-72. [DOI: 10.1007/s00405-014-3393-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/07/2014] [Indexed: 11/27/2022]
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Akaraviputh T, Angkurawaranon C, Phanchaipetch T, Lohsiriwat V, Nimmanwudipong T, Chinswangwatanakul V, Metasate A, Trakarnsanga A, Swangsri J, Taweerutchana V. Platysma myocutaneous flap interposition in surgical management of large acquired post-traumatic tracheoesophageal fistula: A case report. Int J Surg Case Rep 2014; 5:282-6. [PMID: 24727740 DOI: 10.1016/j.ijscr.2014.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Acquired post-traumatic tracheoesophageal fistula (TEF) is an uncommon entity requiring early diagnosis. Among the many strategies in surgical management, we report a case successfully treated with a single-stage tracheal resection and esophageal repair with platysma myocutaneous interposition flap. PRESENTATION OF CASE A 24-year-old man had a motor vehicle accident with head injury and cerebral contusion who required mechanical ventilation support. Three weeks later, he developed hypersecretion, and recurrent episodes of aspiration pneumonia. The chest computed tomography, esophagogastroduodenoscopy, and bronchoscopy revealed a large TEF diameter of 3cm at 4.5cm from carina. Single-stage tracheal resection with primary end-to-end anastomosis and esophageal repair with platysma myocutaneous interposition flap was performed. A contrast esophagography was done on post-operative day 7 and revealed no leakage. He was discharged on post-operative day 10. Esophagogastroduodenoscopy at 1 month revealed patient esophageal lumen. At present he is doing well without any evidence of complications such as esophageal stricture or fistula. DISCUSSION There are many choices of myocutaneous muscle flaps in trachea and esophageal closure or reinforcement. The platysma myocutaneous flap interposition is simple with the advantage of reduced bulkiness. Concern on the vascular supply is that flap should be elevated with the deep adipofascial tissue under the platysma to ensure that the flap survival is not threatened. CONCLUSION The treatment of acquired TEF with platysma myocutaneous flap is an alternative procedure for a large uncomplicated TEF as it is effective, technically ease, minimal donor site defect and yields good surgical results.
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Affiliation(s)
- Thawatchai Akaraviputh
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Chotirot Angkurawaranon
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Teerawit Phanchaipetch
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Visnu Lohsiriwat
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanyadej Nimmanwudipong
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Asada Metasate
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jirawat Swangsri
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Voraboot Taweerutchana
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Murono S, Ishikawa E, Nakanishi Y, Endo K, Kondo S, Wakisaka N, Yoshizaki T. Closure of tracheoesophageal fistula with prefabricated deltopectoral flap. Asian J Surg 2014; 39:243-6. [PMID: 24674898 DOI: 10.1016/j.asjsur.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 12/24/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022] Open
Abstract
Tracheoesophageal fistula (TEF) is a serious complication associated with impaired quality of life. However, a successful TEF closure is difficult owing to the high incidence of recurrence. We utilized a prefabricated deltopectoral (DP) flap for closure of a TEF that occurred after an extended total thyroidectomy. Prefabrication of the inner soft tissue lining the DP flap with a split skin graft was performed prior to surgical closure of a TEF. Esophageal and tracheal mucosa were sutured to the split thickness side and full thickness side of the prefabricated DP flap, respectively. A successful closure of the fistula was achieved with this procedure. Prefabricated DP flap is a useful procedure for the surgical treatment of TEF.
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Affiliation(s)
- Shigeyuki Murono
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Eriko Ishikawa
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yosuke Nakanishi
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuhira Endo
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Satoru Kondo
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Naohiro Wakisaka
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
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Mobashir MK, Basha WM, Mohamed AES, Anany AM. Management of persistent tracheoesophageal puncture. Eur Arch Otorhinolaryngol 2013; 271:379-83. [DOI: 10.1007/s00405-013-2515-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/17/2013] [Indexed: 11/30/2022]
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Mérol JC, Charpiot A, Langagne T, Hémar P, Ackerstaff AH, Hilgers FJM. Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: External humidifier versus heat and moisture exchanger. Laryngoscope 2011; 122:275-81. [DOI: 10.1002/lary.21841] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 02/25/2011] [Accepted: 03/02/2011] [Indexed: 11/08/2022]
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Geyer M, Tan N, Ismail-Koch H, Puxeddu R. A simple closure technique for reversal of tracheoesophageal puncture. Am J Otolaryngol 2011; 32:627-30. [PMID: 21306795 DOI: 10.1016/j.amjoto.2010.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
Abstract
Speech restoration after total laryngectomy has been revolutionized by the technique of tracheoesophageal puncture (TEP) and speech valve prosthesis placement. Unfortunately, complications may arise from this procedure, sometimes necessitating reversal and surgical closure of the TEP. We present a simple yet effective method of closing a TEP and review previously described techniques.
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Abstract
PURPOSE OF REVIEW This paper reviews the advances in surgery in head and neck cancer patients. RECENT FINDINGS Sentinel node biopsy is a promising diagnostic technique to detect occult lymph node metastases, especially in oral carcinomas. Fludeoxyglucose-PET seems to be useful in detecting recurrent (laryngeal) carcinoma after radiotherapy. The role of fludeoxyglucose-PET to detect residual disease in the neck after radiotherapy with or without chemotherapy is not yet clear. The armamentarium of reconstructive surgery is still expanding. Endonasal endoscopic, robotic surgery and image-guided surgery are used as minimal invasive surgery in selected patients. Other advances include photodynamic therapy, ultrasonic surgery and mechanical sutures. SUMMARY New diagnostic techniques are used to avoid futile extensive surgery. Technical improvements have been made to treat head and neck cancer patients with minimal invasive surgery. Large prospective trials are needed to determine the indications for each technique.
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Altorjay Á, Mucs M, Rüll M, Tihanyi Z, Hamvas B, Madácsy L, Paál B. Recurrent, Nonmalignant Tracheoesophageal Fistulas and the Need for Surgical Improvisation. Ann Thorac Surg 2010; 89:1789-96. [DOI: 10.1016/j.athoracsur.2010.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/09/2010] [Accepted: 02/12/2010] [Indexed: 11/27/2022]
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