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Suture‐ligature technique for the closure of tracheocutaneous fistula in adults
Author(s) -
Hauff Samantha J.,
Brisebois Simon,
Moss William,
Merati Albert L.,
Weissbrod Philip A.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27448
Subject(s) - medicine , otorhinolaryngology , head and neck surgery , general surgery , surgery
Although not life threatening, the development of a tracheocutaneous fistula (TCF) after decannulation is a vexing and relatively common long-term complication of a tracheostomy. Rates of TCF reported in the literature range from 13% to 70%, Although the rate of fistula formation is quite low with early decannulation, the risk increases with longer tracheostomy duration, and some studies suggest that as many as 70% of adult patients with a tracheostomy for longer than 16 weeks will develop a TCF. In the pediatric population, 57% of patients develop a TCF after decannulation, and having a tracheostomy in place for greater than 24 months more than doubles the risk of fistula persistence. The presence of a TCF poses social and health challenges for patients: difficulty with phonation, soiling of clothing with mucous, skin irritation, ineffective cough, aspiration of matter via the fistula, and inability to submerge under water can all negatively affect quality of life. The difficulty of successfully closing a TCF is evidenced by the variety of methods described in the literature: primary closure in layers, excision without primary closure, excision with temporary placement of the tracheostomy tube, grafting, coblation, cauterization, local or regional flaps, and free flaps. Failure of a fistula to close postoperatively can present significant morbidity, including infection or collection of subcutaneous air leading to pneumomediastinum, pneumothorax, and subcutaneous emphysema of the neck and face. These latter complications may necessitate reopening of the fistula and, possibly, replacing of the tracheostomy. Here, a simple technique to close a tracheocutaneous fistula is presented that does not require major tissue rearrangement or grafting. This technique has been reported to be successful in the pediatric population, and there is one case report of a fairly similar technique in an adult patient. To our knowledge, this report represents the first reported series of adult patients who have undergone the suture-ligature technique of TCF closure.