The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature

J Med Case Rep. 2015 Nov 1:9:251. doi: 10.1186/s13256-015-0728-z.

Abstract

Introduction: 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.

Case presentation: 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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Cutaneous Fistula / surgery*
  • Forearm / surgery*
  • Free Tissue Flaps / transplantation*
  • Humans
  • Male
  • Neck / surgery
  • Plastic Surgery Procedures / methods*