Department of Surgery, The Division of Plastic Surgery, Albany Medical Center, Albany, New York.
J Burn Care Res. 2020 Jul 3;41(4):887-891. doi: 10.1093/jbcr/iraa035.
Tracheocutaneous fistula (TCF) is a common complication that occurs after decannulation of a long-term tracheostomy. Numerous studies have demonstrated the incidence of TCF formation to positively correlate with an increasing duration of cannulation, specifically in children. Treatment of a persistent TCF in a child has been well described in the literature, with good response to local measures such as curettage and silver nitrate. When this fails, fistulectomy followed by primary closure of the skin or secondary intention yields good results. However, there is a lack of knowledge on TCF formation in pediatric burn-injured patients, where a persistent TCF is a particularly challenging problem to correct given the paucity of supple tissue in the neck and potential for contractures after a large burn injury; effectively making the surgical repairs and management algorithms described in the available literature largely not applicable to this patient population. In this manuscript, we describe a series of pediatric burn patients with persistent TCF, successfully treated with a multilayered closure involving local tissue rearrangement in the form of medial mobilization of the strap muscles of the neck.
气管-皮肤瘘（TCF）是长期气管切开管拔管后常见的并发症。许多研究表明，TCF 的形成与套管留置时间的延长呈正相关，特别是在儿童中。文献中已经很好地描述了儿童持续性 TCF 的治疗方法，局部措施如刮除和硝酸银治疗效果良好。如果这些方法失败，瘘管切除术加皮肤一期或二期闭合可获得良好的效果。然而，对于儿科烧伤患者的 TCF 形成，知识仍然缺乏，由于颈部缺乏柔软组织以及大烧伤后可能出现挛缩，持续性 TCF 是一个特别具有挑战性的问题，有效地使手术修复和管理算法在可用文献中描述的在很大程度上不适用于这一患者群体。在本文中，我们描述了一系列患有持续性 TCF 的儿科烧伤患者，通过颈侧带肌的内侧移位等局部组织重排的多层闭合术成功治疗。
