title: Tracheocutaneous Fistula Closure: Comparison of Rhomboid Flap Repair with Z Plasty Repair in a Case Series of 40 Patients.
abstract: BACKGROUND
  Tracheocutaneous fistula (TCF) is one of the recognized sequelae of a long-term tracheostomy resulting from mucocutaneous overgrowth which prevents closure of the artificial lumen at the site of tracheostomy. Primary closure of TCF has disappointing results and may lead to complications like pneumothorax, pneumomediastinum, cervicofacial subcutaneous emphysema, and depressed scar.
  
  
  OBJECTIVE
  To compare TCF repair using fistulectomy followed by rhomboid flap versus fistulectomy followed by Z plasty repair.
  
  
  METHODS
  In this prospective study, 40 patients of either sex with persistent TCF were included. All patients were randomly divided into two groups. Group I had 20 patients who underwent TCF repair using a technique in which fistulectomy was done followed by its closure in layers, and finally closing the defect using a rhomboid flap. The remaining 20 were included in group II who underwent TCF repair using a technique in which fistulectomy was done followed by layered closing, and final closure of the defect was done using Z plasty. The follow-up period was 3 months.
  
  
  RESULTS
  Out of 40 patients, all but 8 experienced a successful outcome without any complications, and complete aesthetic satisfaction, with improvement in phonation, and no soiling of clothes with mucus or sputum. The 8 unsuccessful patients belonged to group II (Z plasty group).
  
  
  CONCLUSIONS
  Both techniques have been described in the literature and are proven to give good results. Our study emphasizes the fact that in our experience, the rhomboid flap was a better alternative for TCF repair than Z plasty.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of ENT, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, 124001, Haryana, India. hernots@yahoo.com.|Pocket - AP, 115-A, Virat Apartments, Pitampura, Delhi, 110034, India. hernots@yahoo.com.
authors.forename: Sharad
authors.initials: S
authors.lastname: Hernot
authors.affiliation: Department of ENT, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, 124001, Haryana, India.
authors.forename: Raman
authors.initials: R
authors.lastname: Wadhera
authors.affiliation: Department of ENT, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, 124001, Haryana, India.
authors.forename: Madhuri
authors.initials: M
authors.lastname: Kaintura
authors.affiliation: Department of ENT, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, 124001, Haryana, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bhukar
authors.affiliation: Department of ENT, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, 124001, Haryana, India.
authors.forename: Dheeraj Shashikumar
authors.initials: DS
authors.lastname: Pillai
authors.affiliation: Department of ENT, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, 124001, Haryana, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Sehrawat
authors.affiliation: Department of ENT, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, 124001, Haryana, India.
authors.forename: Jitu Sam
authors.initials: JS
authors.lastname: George
mesh_terms: D000328:Adult; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps / Q000145:classification / Q000637:transplantation*; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Rhomboid flap; Tracheocutaneous fistula; Z plasty