Superiorly-based turnover skin flap: Pediatric tracheocutaneous fistula closure

Abstract

Objective: To present a novel superiorly-based turnover skin flap for the primary repair of pediatric tracheocutaneous fistula closure, and to determine the efficacy and safety of this tracheocutaneous fistula turnover flap primary closure technique.

Subject and methods: This retrospective review analyzed one surgeon's (DJK) pediatric tracheostomy decannulation methods and results, specifically relating to the development of tracheocutaneous fistulas, over a fourteen-year period, from October 2002 through June 2016. The review furthermore examined a turnover flap technique for the primary closure of tracheocutaneous fistulas described herein.

Results: Over the period of study, 57 patients were decannulated, of whom 31 (54%) developed a tracheocutaneous fistula. Mean duration of tracheostomy in patients who developed a tracheocutaneous fistula following decannulation was forty-two months compared to thirteen months in patients who did not. Duration of decannulation was an independently significant variable (P < .001) in tracheocutaneous fistula development while gender, age at tracheostomy and age at decannulation were not (P > .05). Of the 31 patients who developed a tracheocutaneous fistula, 30 (97%) elected to pursue tracheocutaneous fistula closure using the turnover flap technique described in this study. Mean time from decannulation to tracheocutaneous fistula repair was 132 days. All tracheocutaneous fistulas were successfully closed. There were no perioperative or postoperative complications and no patient required subsequent hospitalization or surgical revision.

Conclusions: The turnover technique presented is simple, straightforward, reliable, safe, and effective with excellent cosmetic results.

Keywords: Closure technique; Pediatric; Tracheocutaneous fistula; Tracheostomy.