Published in:
Open Access 01-12-2015 | Case report
The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature
Published in: Journal of Medical Case Reports | Issue 1/2015
Login to get accessAbstract
Introduction
The closure of complex tracheocutaneous fistulae is a surgical challenge. We describe a staged approach for management of a patient with a large tracheocutaneous fistula in the setting of prior surgery and local radiation therapy.
Case presentation
A 66-year-old Caucasian man who had undergone prior surgery and radiation therapy to the lower neck presented to our hospital for treatment of a large tracheocutaneous fistula that had developed with an adjacent area of tracheal stenosis. A prefabricated composite graft made up of an inner mucosal lining (buccal mucosa), a central cartilage structure (conchal cartilage), and external skin lining was constructed on the patient’s distal volar forearm and subsequently harvested in a staged fashion. This graft was transferred as a free flap and successfully used to close the patient’s defect following revascularization. Sixty months after surgery, the patient had no airway compromise or new dysphonia.
Conclusions
The use of a prefabricated mucosally lined composite graft can allow for successful closure of large tracheocutaneous fistulae, even in the setting of prior radiation therapy.