Akaraviputh Thawatchai, Angkurawaranon Chotirot, Phanchaipetch Teerawit, Lohsiriwat Visnu, Nimmanwudipong Thanyadej, Chinswangwatanakul Vitoon, Metasate Asada, Trakarnsanga Atthaphorn, Swangsri Jirawat, Taweerutchana Voraboot
Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Int J Surg Case Rep. 2014;5(5):282-6. doi: 10.1016/j.ijscr.2014.03.017. Epub 2014 Mar 25.
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.
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.
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.
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.
后天性创伤性气管食管瘘（TEF）是一种罕见疾病，需要早期诊断。在手术治疗的众多策略中，我们报告一例通过一期气管切除、食管修复并置入颈阔肌肌皮瓣成功治疗的病例。
一名24岁男性因机动车事故导致头部受伤和脑挫伤，需要机械通气支持。三周后，他出现分泌物过多及反复发生的吸入性肺炎。胸部计算机断层扫描、食管胃十二指肠镜检查和支气管镜检查显示，在距隆突4.5厘米处有一个直径3厘米的大型TEF。实施了一期气管切除并进行端端吻合，以及食管修复并置入颈阔肌肌皮瓣。术后第7天进行了食管造影，未发现渗漏。他于术后第10天出院。术后1个月的食管胃十二指肠镜检查显示患者食管腔正常。目前他情况良好，没有食管狭窄或瘘等并发症的迹象。
在气管和食管闭合或加固方面，有多种肌皮瓣可供选择。置入颈阔肌肌皮瓣操作简单，具有减少臃肿的优点。关于血管供应的问题是，应在颈阔肌下方连同深部脂肪筋膜组织一起掀起皮瓣，以确保皮瓣存活不受威胁。
对于大型无并发症的TEF，采用颈阔肌肌皮瓣治疗是一种替代方法，因为它有效、技术操作简便、供区缺损最小且手术效果良好。
