Rezapanah Alireza, Emadi Elaheh, Alamdari Daryoush Hamidi
Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Int J Surg Case Rep. 2024 Mar;116:109335. doi: 10.1016/j.ijscr.2024.109335. Epub 2024 Feb 2.
Recalcitrant esophagocutaneous fistula is a very uncommon complication after neck surgery. Management of this non-healing fistula has long been a topic of debate. This report provides an approach for treating it.
A 65-year-old woman presented nineteen years after branchial cleft cyst surgery with cyst recurrence associated with swelling. Sonography displayed a collection in the front of the left carotid artery in the suprasternal notch. On the CT, a similar finding was seen, a collection with gaseous density in front of the left sternocleidomastoid and a hypodense nodule on the right lobe of the thyroid. The pathology report describes an abscess with many macrophages and neutrophils, fat necrosis, microcalcification, and foreign body reaction around amorphous bodies. Again, surgical resection of the swelling area and tract was done and an esophago-cutaneous fistula was developed after surgery which did not heal after 6 months.
According to accelerating the healing time and complete closure of chronic wounds such as lower-extremity diabetic ulcers, persistent pneumothorax, anal fistula, and recalcitrant gastrocutaneous fistula by using platelet-rich plasma (PRP) and fibrin glue (FG); PRP-FG can be considered as a safe and effective treatment option for chronic wound healing. So, for treatment of this fistula, PRP-FG was used. PRP-FG was obtained from the patient's blood and injected into the fistula tract. The discharge was stopped after one week and the fistula was cured.
PRP-FG injection into the fistula tract provides a simple and non-invasive approach for the treatment of recalcitrant esophagocutaneous fistula.
顽固性食管皮肤瘘是颈部手术后一种非常罕见的并发症。这种不愈合瘘管的处理长期以来一直是一个有争议的话题。本报告提供了一种治疗方法。
一名65岁女性在鳃裂囊肿手术后19年出现囊肿复发并伴有肿胀。超声检查显示胸骨上切迹处左颈动脉前方有一液性暗区。CT检查有类似发现，左胸锁乳突肌前方有一含气体密度的液性暗区，甲状腺右叶有一低密度结节。病理报告描述为一个脓肿，有许多巨噬细胞和中性粒细胞、脂肪坏死、微钙化以及无定形物周围的异物反应。再次对肿胀区域和瘘管进行手术切除，术后形成了食管皮肤瘘，6个月后仍未愈合。
根据使用富血小板血浆（PRP）和纤维蛋白胶（FG）可加速下肢糖尿病溃疡、持续性气胸、肛瘘和顽固性胃皮肤瘘等慢性伤口的愈合时间并实现完全闭合；PRP-FG可被视为慢性伤口愈合的一种安全有效的治疗选择。因此，对于该瘘管的治疗，采用了PRP-FG。PRP-FG取自患者自身血液并注入瘘管。一周后瘘管停止排液，瘘管治愈。
向瘘管内注射PRP-FG为治疗顽固性食管皮肤瘘提供了一种简单且无创的方法。
