title: Reducing fistula rates following laryngotracheal separation.
abstract: OBJECTIVE
  Laryngotracheal separation (LTS) is an uncommonly performed but highly effective procedure for intractable aspiration in patients with amyotrophic lateral sclerosis and other neurodegenerative conditions. Previously published series have noted rates of postoperative tracheocutaneous fistula formation as high as 1 in 3 patients. This report details the use of a muscle flap-reinforced imbrication technique to reduce the incidence of fistula formation after LTS surgery.
  
  
  METHODS
  All patients who underwent LTS surgery at the reporting institutions between 2004 and 2010 were identified. The principal diagnosis, patient characteristics, the presence of a preexisting tracheotomy, and postoperative complications were recorded. We describe the technique for imbrication closure of the proximal stump with strap muscle reinforcement.
  
  
  RESULTS
  Thirteen patients (10 male, 3 female; median age, 53 years; interquartile range, 45 to 66 years) underwent the LTS procedure; amyotrophic lateral sclerosis was the principal diagnosis in 8 of the 13 patients. Six patients had a preexisting tracheotomy. None developed tracheocutaneous fistula, hematoma, or wound infection. Two patients required stomaplasty at a later date.
  
  
  CONCLUSIONS
  Strap muscle flap-reinforced imbrication closure of the proximal tracheal stump after LTS surgery allows for a low incidence of postoperative fistula formation.
authors.affiliation: Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
authors.forename: Joel
authors.initials: J
authors.lastname: Blumin
authors.forename: Albert
authors.initials: A
authors.lastname: Merati
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D017577:Cutaneous Fistula / Q000517:prevention & control*; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D016156:Respiratory Tract Fistula / Q000517:prevention & control*; D013524:Surgical Flaps; D014133:Tracheal Diseases / Q000517:prevention & control*; D014140:Tracheotomy