title: An approach to complex tracheostomal complications.
abstract: Fistula formation following laryngectomy, most commonly pharyngocutaneous, is the most feared non-fatal complication with an incidence range from 5 to 30%. Tracheoesophageal fistulae are rare and are, most often, associated with the creation of a surgical speech fistula or the stomal recurrence of a malignant tumour. We present five cases of complex post-laryngectomy fistulae and a new approach to management. We advocate debridement of infected or necrotic tissue, primary suture of the oesophageal and tracheal defects with interposition of healthy viable tissue as a free transfer. If necessary, the trachea can be mobilised and the tracheostome is lowered to healthy tissue outside the radiotherapy field, with excision of the manubrium and hemi-clavicles. This technique allows reconstruction as a single stage procedure and does not preclude the future creation of a further tracheoesophageal fistula for voice rehabilitation.
authors.affiliation: Department of Plastic, Hand and Reconstructive Surgery, St James's Hospital, Beckett Street, Leeds LS9 7TF, UK. dr.chris.baldwin@btinternet.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Baldwin
authors.forename: M I
authors.initials: MI
authors.lastname: Liddington
mesh_terms: D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010608:Pharyngeal Diseases / Q000209:etiology / Q000601:surgery; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery; D016879:Salvage Therapy / Q000379:methods; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects*