title: Repair of challenging non-malignant tracheo- or broncho-oesophageal fistulas by extrathoracic muscle flaps.
abstract: OBJECTIVE
  Evaluation of complex, acquired, non-malignant tracheo/broncho-oesophageal fistulas (TEF) repaired by extrathoracic pedicled muscle flaps that were, in addition to their interposition between the airways and the gastro-intestinal tract, patched into gastro-intestinal or airway defects if primary closure seemed risky.
  
  
  METHODS
  A single institution experience of patients treated between 2003 and 2015. Twenty-two patients required TEF repair following oesophageal surgery (18), Boerhaave syndrome (1), chemotherapy for mediastinal lymphoma (1), carinal resection and irradiation (1) and laryngectomy (1); 64% of them underwent prior radio- or chemotherapy and 50% prior airway or oesophageal stenting.
  
  
  RESULTS
  Airway defects were closed by muscle flap patch ( n  = 12), lobectomy ( n  = 4), airway resection/anastomosis ( n  = 2), pneumonectomy ( n  = 1), segmentectomy ( n  = 2) or primary suture ( n  = 1). Gastro-intestinal defects were repaired by oesophageal diversion ( n  = 9), muscle flap patch ( n  = 8) or primary suture ( n  = 5). A muscle flap patch was used to close airway and gastro-intestinal defects in 55% and 36% of cases, respectively. The 90-day postoperative mortality and TEF recurrence rates were 18% and 4.5%. Airway healing and breathing without tracheal appliance was obtained in 95% of patients and gastro-intestinal healing in 77% of those without oesophageal diversion. Five of nine patients with oesophageal diversion underwent intestinal restoration by retrosternal colon transplants.
  
  
  CONCLUSIONS
  Complex TEF arising after oesophageal surgery, radio-chemotherapy or failed stenting can be successfully closed using extrathoracic muscle flaps that can, in addition to their interposition between the airway and the gastro-intestinal tract, also be patched into gastro-oesophageal or airway defects if primary closure seems hazardous.
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Petra
authors.initials: P
authors.lastname: Rosskopfova
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Jean Yannis
authors.initials: JY
authors.lastname: Perentes
authors.affiliation: Division of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Krueger
authors.affiliation: Division of Pulmonology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Alban
authors.initials: A
authors.lastname: Lovis
authors.affiliation: Division of Gastoenterology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Gian
authors.initials: G
authors.lastname: Dorta
authors.affiliation: Division of Anaesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Moira
authors.initials: M
authors.lastname: Baeriswyl
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Hans-Beat
authors.initials: HB
authors.lastname: Ris
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D014132:Trachea / Q000601:surgery*; D014138:Tracheoesophageal Fistula / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
keywords: Airway; Neoadjuvant induction therapy; Oesophageal surgery; Tracheal surgery; Tracheo-oesophageal fistula