Royer Allison K, Royer Mark C, Ting Jonathan Y, Weisberger Edward C, Moore Michael G
Columbus ENT and Allergy, Columbus Regional Health, Columbus, IN, USA.
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 550 North University Boulevard, Room 3170, Indianapolis, IN, 46202, USA.
J Med Case Rep. 2015 Nov 1;9:251. doi: 10.1186/s13256-015-0728-z.
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.
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.
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.
复杂气管皮肤瘘的闭合是一项外科挑战。我们描述了一种分阶段方法来处理一名在既往手术和局部放射治疗背景下患有大型气管皮肤瘘的患者。
一名66岁的白种男性，此前曾接受过下颈部手术和放射治疗，因出现一个伴有相邻气管狭窄区域的大型气管皮肤瘘而到我院就诊。在患者的掌侧前臂远端构建了一个预制复合移植物，其由内层黏膜衬里（颊黏膜）、中央软骨结构（耳甲软骨）和外层皮肤衬里组成，随后分阶段获取。该移植物作为游离皮瓣转移，并在血管再通后成功用于闭合患者的缺损。术后60个月，患者气道无受压情况，也未出现新的发声困难。
使用预制的带黏膜复合移植物能够成功闭合大型气管皮肤瘘，即使是在既往接受过放射治疗的情况下。
