European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026
A multilayer full-thickness skin graft technique for closure of recurrent tracheoesophageal puncture fistula: case report and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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AlRahim Ahmed Abdulrahman, AlHashim Mohammed Abdulrahman, Aljaafari Abdullah Omar, AlNaimi Shaykhah Nasser, Al-Turaiki Turki M, Alhindi Anas Talal, Alanazi Rawan Abdulrahman
Аннотация
BACKGROUND: Tracheoesophageal puncture (TEP) is a widely used method of voice rehabilitation following total laryngectomy; however, it is associated with complications, including persistent leakage and tracheoesophageal fistula (TEF). Management of recurrent TEF can be challenging, especially in patients with prior radiotherapy and impaired wound healing.
CASE PRESENTATION: This paper reports a case of a 44-year-old male with advanced glottic squamous cell carcinoma who underwent total laryngectomy with flap reconstruction and adjuvant radiotherapy, followed by TEP for voice rehabilitation. The patient developed a persistent tracheoesophageal fistula refractory to conservative management, prosthesis removal, endoscopic closure, and open surgical repair with muscle flap interposition. Definitive revision surgery was performed using a composite right inguinal graft, consisting of a dermal-fascial layer to create a double-layer seal between the trachea and esophagus and an external full-thickness skin graft to reinforce the stoma. Postoperative imaging confirmed fistula closure, and the patient ultimately resumed full oral intake without aspiration.
CONCLUSION: This case demonstrates that a multilayered repair using a full-thickness skin graft combined with a dermal-fascial interposition can achieve successful closure of a recurrent tracheoesophageal fistula. This approach may represent an effective and less invasive alternative prior to consideration of free flap reconstruction in selected patients.
CASE PRESENTATION: This paper reports a case of a 44-year-old male with advanced glottic squamous cell carcinoma who underwent total laryngectomy with flap reconstruction and adjuvant radiotherapy, followed by TEP for voice rehabilitation. The patient developed a persistent tracheoesophageal fistula refractory to conservative management, prosthesis removal, endoscopic closure, and open surgical repair with muscle flap interposition. Definitive revision surgery was performed using a composite right inguinal graft, consisting of a dermal-fascial layer to create a double-layer seal between the trachea and esophagus and an external full-thickness skin graft to reinforce the stoma. Postoperative imaging confirmed fistula closure, and the patient ultimately resumed full oral intake without aspiration.
CONCLUSION: This case demonstrates that a multilayered repair using a full-thickness skin graft combined with a dermal-fascial interposition can achieve successful closure of a recurrent tracheoesophageal fistula. This approach may represent an effective and less invasive alternative prior to consideration of free flap reconstruction in selected patients.