Jaiswal Dushyant, Yadav Prabha, Shankhdhar Vinay Kant, Gujjalanavar Rajendra Suresh, Puranik Prashant
Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Plast Surg. 2015 Sep-Dec;48(3):278-82. doi: 10.4103/0970-0358.173125.
Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC) transposition flap for the closure of tracheoesophageal fistula.
An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea.
This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases) and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation.
This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula.
气管食管发音假体在全喉切除术后恢复言语功能方面非常有效。尽管这是一种安全的方法，但在某些情况下，假体周围会出现扩张或渗漏，需要闭合气管食管瘘。非手术和手术闭合方法均有相关报道。当非手术方法失败时采用手术方法。我们介绍使用胸锁乳突肌肌皮瓣闭合气管食管瘘。
在气管造口周围的黏膜皮肤交界处做环形切口。向下解剖气管食管间隙直至瘘口及其以外。切断气管食管通道。用简单缝线闭合食管黏膜。然后掀起胸锁乳突肌肌皮瓣并转移覆盖缝合的食管以及食管与气管之间的缺损处。
本研究前瞻性地进行了1年，从2012年6月至2013年5月。该技术用于颈部皮肤柔软的患者。9例患者接受了此手术（9例为蒂在下的皮瓣），8例成功。1例皮瓣前缘裂开并伴有食管裂开，需要再次手术。2例皮瓣边缘坏死，未进行任何干预自行愈合。本系列中的9例患者均接受过放疗。
对于需要永久性闭合气管食管瘘且颈部皮肤柔软的患者，这种闭合方法简单有效。
