Fuentes VE, Martín GMA, Pérez J, Placeres ZA

Language: Spanish
References: 8
Page: 18-24
PDF size: 129.82 Kb.

ABSTRACT

Introduction: Persistent tracheal stoma or tracheocutaneous fistula is a late tare complication that is characterized by permanence of a tracheal orifice for 3 to 6 months after removing the tracheostomy cannula.
Objective: To describe the characteristics and the results achieved in patients who presented with tracheocutaneous fistula after removing the inserted T-tube to treat ischemic stenosis of the trachea and subglottis.
Methods: A series of 20 patients with tracheocutaneous fistula were treated at the general surgery service of “Hermanos Ameijeiras” hospital from June 1993 through January 2011. The characteristics of the patients in terms of age, sex, surgical indication, length of time for the removal of the T-tube and details of the surgical technique were described.
Results: The length of time elapsed until the T-tube removal ranged from 3 to 163 months. Nine patients remained with the inserted T-tube for 12 months. The cannula was removed in 2 patients after 13 to 36 months and 9 were taken the cannula out after 37 months or more. The number of patients treated with cutaneous flaps amounted to 18 with single suture. Two patients suffered wound infection, both from the group under cutaneous flap treatment; one of them had fistula recurrence which was finally managed after reoperation. The follow-up lasted 6 to 61 months including the reoperated patient. Neither fistula nor stenosis recurrences were observed anymore.
Conclusions: The surgical treatment with cutaneous flap is effective to treat tracheocutaneous fistula that may appear when the T-tube is removed.

REFERENCES

1. White AK, Smitheringale AJ. Treatment of tracheocutaneous fistulae in children. J Otolaryngol. 1989;18(1):49-52.

2. Shen KR, Mathisen DJ. Management of persistent trachealstoma. Chest Surg Clin N Am. 2003;13:369-73.

3. Sautter NB, Krakovitz PR, Solares CA, Koltai PJ. Closure of persistent tracheocutaneous fistula following "starplasty" tracheostomy in children. Int J Pediatr Otorhinolaryngol. 2006;70(1):99-105.

4. Grillo HC. Tracheostomy, Minitracheostomy, and Closure of Persistent Stoma. In Grillo HC (ed). Surgery of trachea and bronchi. Chap 22 United States BC DeckerInc. 2004:499-506.

5. Gallagher TQ, Hartnick CJ. Tracheocutaneous fistula closure. Adv Otorhinolaryngol. 2012;73:76-9.

6. Stern Y, Cosenza M, Walner DL, Cotton RT. Management of persistent tracheocutaneous fistula in the pediatricagegroup. Ann Otol Rhinol Laryngol. 1999;108(9):880-3.

7. Lewis VL Jr, Manson PN, Stalnecker MC. Some ancillary procedures for correction of depressed adherent tracheostomy scars and associated tracheocutaneous fistulae. J Trauma. 1987;27(6):651-5.

8. Bishop JB, Bostick J, Nahai F. Persistent tracheostomystoma. Am J Surg. 1980;140(5):709-10.