Post-radiation tracheoesophageal fistula following salvage laryngectomy: microsurgical repair using a “bi-laminar-lateral arm flap

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• 作者：Anita T. Mohan (1)
  Charles M. Malata (1) (2)
  
• 关键词：Tracheoesophageal fistula ; Microsurgical reconstruction ; Head and neck oncology ; Head and neck reconstruction ; Total laryngectomy ; Microsurgery ; Free flap ; Lateral arm free flap ; Fasciocutaneous free flap
• 刊名：European Journal of Plastic Surgery
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：37
• 期：12
• 页码：683-686
• 全文大小：498 KB
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• 作者单位：Anita T. Mohan (1)
  Charles M. Malata (1) (2)
  
  1. Department of Plastic and Reconstructive Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambrige, CB2 0QQ, UK
  2. Anglia Ruskin University Postgraduate Medical Institute, Cambridge & Chelmsford, UK
  
• ISSN：1435-0130

文摘

Post-radiotherapy tracheoesophageal fistula (TOF) is a serious complication following salvage laryngectomy, associated with severe morbidity and high mortality. In the absence of recurrent disease, they commonly follow creation of a tracheoesophageal puncture for speech rehabilitation after total laryngectomy. Frequently, direct closure, local and regional flaps repairs are unsuccessful, further making the bed hostile or challenging for definitive treatment. We report using a free fasciocutaneous lateral arm flap, folded to create a bi-laminar (epithelial) reconstruction for salvage repair of large, high output persistent TOF initiated by tracheoesophageal puncture following total laryngectomy, two previous courses of radiotherapy and two unsuccessful repairs using small local flap and a pedicled pectoralis major. The folded lateral arm free flap provided resolution of the fistula, interposition of well-vascularised soft tissue, in addition to oesophageal lining and external tension-free cutaneous coverage, while maintaining a patent endotracheostomy. Chronic high output fistulas present extremely high risk and post-operative complications and necessitate complex reconstruction. Careful surgical planning, multidisciplinary approach and conservative measures to optimise the patient are paramount to achieve success. Microsurgical reconstruction provides an alternate and important adjunct in salvage repair of persistent and large TOFs. Level of Evidence: Level V, therapeutic study.