Service d'Anesthésie Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
Service de Chirurgie ORL, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
Int J Oral Maxillofac Surg. 2022 Jul;51(7):883-885. doi: 10.1016/j.ijom.2021.11.011. Epub 2021 Dec 4.
Tracheoesophageal fistula results in persistent leakage of saliva into the trachea, prevents oral feeding, and predisposes to aspiration pneumonia. Large fistula closure may require a free flap to cover the defect. When the defect involves the tracheal area between the neck and the mediastinum, a tubeless field for optimal exposure can be advantageous. This article reports the use of veno-venous extracorporeal lung support, a known safe and efficient technique to support the patient's respiratory function, for this purpose. The typical veno-venous extracorporeal lung support setting includes a femoro-jugular bypass. The patient cases reported here had characteristics that precluded the use of the jugular vein, such as neck radiation dermatitis, previous radical neck dissection, and poor accessibility. Therefore a more rarely described femoro-femoral approach was used. The cases of three patients with persistent tracheoesophageal fistula who had free flap surgeries (two bi-paddled radial forearm free flap and one latissimus dorsi muscle free flap) assisted by femoro-femoral veno-venous extracorporeal lung support are reported.
气管食管瘘会导致唾液持续流入气管，妨碍口服喂养，并易引发吸入性肺炎。大的瘘口闭合可能需要游离皮瓣来覆盖缺损。当缺损涉及颈部和纵隔之间的气管区域时，无管野外可获得最佳暴露，这是有利的。本文报告了使用静脉-静脉体外肺支持（一种已知安全有效的支持患者呼吸功能的技术）来达到这一目的。典型的静脉-静脉体外肺支持设置包括股-颈旁路。这里报告的患者病例具有颈静脉无法使用的特点，如颈部放射性皮炎、先前的根治性颈清扫术和难以接近。因此，采用了一种较少描述的股-股方法。报告了三例因持续性气管食管瘘而行游离皮瓣手术（两例双叶桡动脉游离皮瓣和一例背阔肌游离皮瓣）的患者，这些手术均由股-股静脉-静脉体外肺支持辅助完成。
