Dewey Eliza H, Castro Jerry R, Mojica Jacqueline, Lazarus Cathy L, Su Henry K, Alpert Erin H, Dos Reis Laura L, Urken Mark L
Thyroid Head and Neck Cancer (THANC) Foundation, New York, New York.
Department of Head and Neck - Otolaryngology, Mount Sinai Beth Israel, New York, New York.
Head Neck. 2016 Apr;38 Suppl 1:E172-8. doi: 10.1002/hed.23966. Epub 2015 Jun 18.
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.
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.
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.
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.
我们的手术方法描述了一种双叶桡侧前臂游离皮瓣（RFFF），用于全喉切除术后慢性气管食管瘘（TEF）患者的瘘口封闭。取得了预期的功能效果。
8例患者接受了该手术。手术方法包括瘘管的暴露和切除，以及双叶RFFF转移。关键手术操作包括：气管的环形解剖和游离；部分病例行胸骨部分切除；将皮瓣的远端叶植入食管前壁；将近端皮肤叶植入气管后壁和颈部皮肤。
8例均成功重建，恢复了正常饮食，气管造口通畅。1例患者出现延迟性食管狭窄，经家庭扩张成功处理。
已有多种TEF治疗方法的报道。我们87.5%的食管腔保留成功率、气道的重建以及术后过程无并发症，证明了这种手术方法的可靠性。©2015威利期刊公司。《头颈》38:E172 - E178，2016。
