title: Tracheo-graft fistulae following pharyngo-laryngo-oesophagectomy. A cause and its prevention.
abstract: Tracheo-graft fistulae developed in two patients who required intermittent positive pressure ventilation and intubation with conventional cuffed tracheostomy tubes following resection of post-cricoid carcinomata by pharyngolaryngo-oesophagectomy. Pressure necrosis of the posterior tracheal muscle and the anterior wall of the graft occurred as a direct result of compression of these structures between the tracheostomy cannula and air cuff, and the vertebral bodies at the thoracic inlet. This post-operative complication has not been encountered in subsequent resections since the introduction and routine use of a modified cuffed tracheostomy tube. The adjustable neck plate guards against trauma to the tracheostome, inadvertent intubation of one of the major bronchi in each individual patient and the siting of the cuff beyond the thoracic inlet. Unintentional over-inflation of air cuffs remains a hazard whereas only ambient air re-expands the foam cuff. This property of the cuff also ensures against surgical injury to the posterior tracheal wall during the operation. Pressure necrosis of the posterior tracheal wall by the main tracheostomy cannula is minimised by suitably modifying the curvature and length of the cannula for use in patients with end-tracheostomies.
mesh_terms: D000368:Aged; D003106:Colon / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology*; D005747:Gastric Fistula / Q000209:etiology; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D010611:Pharyngectomy / Q000009:adverse effects; D011183:Postoperative Complications; D014133:Tracheal Diseases / Q000209:etiology*; D014140:Tracheotomy / Q000009:adverse effects; D014182:Transplantation, Autologous