title: A persistent tracheocutaneous fistula closed with two hinged skin flaps and rib cartilage interpositional grafting.
abstract: Persistent tracheal fistula after tracheostomy decannulation is a recognized sequel to long-term tracheostomy use, causing important morbidity including difficult to vocalization and control of air secretions, recurrent pulmonary infections, and cosmetic and social problems. Herein, we reported a new method for closure of persistent tracheocutaneous fistula with rib cartilages. Compared to other techniques previously reported, the variations of our strategy were the use of temporary metal-covered tracheal stent and the hinged turnover skin bi-flaps reinforced with rib cartilage grafts. Rib cartilages were useful in order to reconstruct the trachea and prevent stenosis. Since it become difficult to obtain the maintenance of the trachea stability until healing of suture was well established, a covered metallic stent was also inserted to avoid flap collapse. The stent was removed 3 months later. Six months follow-up showed normal tracheal patency.
authors: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy.
authors: Francesco Paolo
authors: FP
authors: Caronia
authors: Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy. alfonso.fiorelli@unina2.it.
authors: Alfonso
authors: A
authors: Fiorelli
authors: Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy.
authors: Mario
authors: M
authors: Santini
authors: GB Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy.
authors: Sergio
authors: S
authors: Castorina
mesh_terms: D066186:Costal Cartilage / Q000637:transplantation*; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods*; D015607:Stents / Q000009:adverse effects; D013524:Surgical Flaps; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects; D014945:Wound Healing; D055815:Young Adult
keywords: Reconstruction; Rib cartilage graft; Skin flap; Surgery; Tracheocutaneous fistula