title: The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature.
abstract: BACKGROUND
  The closure of complex tracheocutaneous fistulae is a surgical challenge. We describe a staged approach for management of a patient with a large tracheocutaneous fistula in the setting of prior surgery and local radiation therapy.
  
  
  METHODS
  A 66-year-old Caucasian man who had undergone prior surgery and radiation therapy to the lower neck presented to our hospital for treatment of a large tracheocutaneous fistula that had developed with an adjacent area of tracheal stenosis. A prefabricated composite graft made up of an inner mucosal lining (buccal mucosa), a central cartilage structure (conchal cartilage), and external skin lining was constructed on the patient's distal volar forearm and subsequently harvested in a staged fashion. This graft was transferred as a free flap and successfully used to close the patient's defect following revascularization. Sixty months after surgery, the patient had no airway compromise or new dysphonia.
  
  
  CONCLUSIONS
  The use of a prefabricated mucosally lined composite graft can allow for successful closure of large tracheocutaneous fistulae, even in the setting of prior radiation therapy.
authors.affiliation: Columbus ENT and Allergy, Columbus Regional Health, Columbus, IN, USA. allison.k.royer@gmail.com.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Royer
authors.affiliation: Columbus ENT and Allergy, Columbus Regional Health, Columbus, IN, USA. mark.c.royer@gmail.com.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Royer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 550 North University Boulevard, Room 3170, Indianapolis, IN, 46202, USA. jting@iuhealth.org.
authors.forename: Jonathan Y
authors.initials: JY
authors.lastname: Ting
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 550 North University Boulevard, Room 3170, Indianapolis, IN, 46202, USA. eweiser@iupui.edu.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Weisberger
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 550 North University Boulevard, Room 3170, Indianapolis, IN, 46202, USA. mooremg@iupui.edu.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Moore
mesh_terms: D000368:Aged; D017577:Cutaneous Fistula / Q000601:surgery*; D005542:Forearm / Q000601:surgery*; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D009333:Neck / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*