Reducing fistula rates following laryngotracheal separation. Ann Otol Rhinol Laryngol 2012 Mar;121(3):151-5
Date
04/26/2012Pubmed ID
22530473DOI
10.1177/000348941212100302Scopus ID
2-s2.0-84858257146 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
OBJECTIVES: Laryngotracheal separation (LTS) is an uncommonly performed but highly effective procedure for intractable aspiration in patients with amyotrophic lateral sclerosis and other neurodegenerative conditions. Previously published series have noted rates of postoperative tracheocutaneous fistula formation as high as 1 in 3 patients. This report details the use of a muscle flap-reinforced imbrication technique to reduce the incidence of fistula formation after LTS surgery.
METHODS: All patients who underwent LTS surgery at the reporting institutions between 2004 and 2010 were identified. The principal diagnosis, patient characteristics, the presence of a preexisting tracheotomy, and postoperative complications were recorded. We describe the technique for imbrication closure of the proximal stump with strap muscle reinforcement.
RESULTS: Thirteen patients (10 male, 3 female; median age, 53 years; interquartile range, 45 to 66 years) underwent the LTS procedure; amyotrophic lateral sclerosis was the principal diagnosis in 8 of the 13 patients. Six patients had a preexisting tracheotomy. None developed tracheocutaneous fistula, hematoma, or wound infection. Two patients required stomaplasty at a later date.
CONCLUSIONS: Strap muscle flap-reinforced imbrication closure of the proximal tracheal stump after LTS surgery allows for a low incidence of postoperative fistula formation.
Author List
Francis DO, Blumin J, Merati AAuthor
Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Amyotrophic Lateral Sclerosis
Cutaneous Fistula
Deglutition Disorders
Female
Humans
Larynx
Male
Middle Aged
Otorhinolaryngologic Surgical Procedures
Postoperative Complications
Respiratory Tract Fistula
Surgical Flaps
Tracheal Diseases
Tracheotomy