Wreesmann Volkert B, Smeele Ludi E, Hilgers Frans J M, Lohuis Peter J F M
Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Head Neck. 2009 Jun;31(6):838-42. doi: 10.1002/hed.20971.
Tracheoesophageal fistula (TEF) is a rare but serious complication associated with high mortality rates. Traditional management of TEF includes primary closure with or without interposition of regional tissue flaps but is associated with a significant recurrence risk, especially in case of larger fistulas. Application of microvascular free flap reconstruction is an emerging alternative in the surgical management of large TEFs, but may be limited by issues of flap bulkiness and requirement for neoepithelialization across the large inner flap surface.
Here, we report prefabrication of a bilaminar radial forearm free flap to successfully close a large recurrent TEF that occurred years after tracheoesophageal puncture-based voice rehabilitation in a laryngectomized patient.
The bilaminar radial forearm free flap may prove to be an important adjunct to the closure of large TEFs.
气管食管瘘（TEF）是一种罕见但严重的并发症，死亡率很高。TEF的传统治疗方法包括一期缝合，可选择或不选择置入局部组织瓣，但存在显著的复发风险，尤其是在瘘口较大的情况下。微血管游离皮瓣重建术在大型TEF的外科治疗中是一种新兴的替代方法，但可能受到皮瓣臃肿以及大的皮瓣内表面需要新上皮化等问题的限制。
在此，我们报告了一例喉切除术后患者，在基于气管食管穿刺的语音康复多年后发生了大型复发性TEF，通过预制双层桡侧前臂游离皮瓣成功将其闭合。
双层桡侧前臂游离皮瓣可能被证明是闭合大型TEF的重要辅助手段。
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