Treatment of malignant tracheoesophageal fistula with …
This method of closure is simple and effective for those patients with pliable neck skin who require permanent closure of the tracheoesophageal fistula.
of Pharyngocutaneous Fistula; Tracheoesophageal Voice ..
Tracheoesophageal puncture (TEP) with the insertion of voice prosthesis represents a useful and safe method for voice restoration after total laryngectomy. This has become the most reliable and accepted modality of speech rehabilitation. Most patients do well with TEP, but a leakage of saliva or ingested food around the prosthesis does occur with the reported rate ranging from 7% to 42% of the cases. This is often due to a fistula that is too large to accommodate a valve without leakage. In addition, when the prosthesis is too long for the tract, it enlarges the fistula. Also situations occur in which a stenosis occurs below the puncture site, which allows pooling of secretions in the area and leakage around a properly fitted prosthesis. Numerous measures have been advocated to tackle this problem, with none of them giving a satisfactory outcome. Downsizing the insertion of the prosthesis with larger inner flanges, augmentation or narrowing of the party wall between the trachea and the oesophagus are among few of the suggested methods. When these conservative measures fail or when the fistula is too large, its surgical closure may become necessary. The objectives of surgery are dissection and disconnection of fistula, closure of oesophagus after dissecting the party wall between the trachea and the oesophagus, tracheostoma relocation at previous TEP site, tracheostomal stenosis correction, interposition of muscle and skin flap, these form a main stages of the surgical obturation of the fistula. We present a technique wherein a sternocleidomastoid musculocutaneous (SCMMC) transposition flap is used as a pedicle flap to interpose between the party walls after layered closure of oesophagus and relocation of trachea at the TEP site. This reliable and simple technique provides good vascular tissue for closure.
This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula.