Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-06-07T02:18:09.462Z Has data issue: false hasContentIssue false
  • English
  • Français

Internal mammary artery perforator flap in the management of tracheoesophageal fistulae

Published online by Cambridge University Press:  08 January 2024

Amrita Kaur Open the ORCID record for Amrita Kaur [Opens in a new window]  and
Gautam Biswas
Amrita Kaur*
Affiliation:
Department of Plastic Surgery, Tata Medical Centre, Kolkata, India
Gautam Biswas
Affiliation:
Department of Plastic Surgery, Tata Medical Centre, Kolkata, India
*
Corresponding author: Amrita Kaur; Email: plasticsurgeryamrita@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

A pathological communication between the trachea and oesophagus – a tracheoesophageal fistula – may be congenital or acquired, benign or malignant, necessitating a multidisciplinary approach. Conservative attempts at closure of this abnormal connection are ineffective; the interposition of healthy vascular tissue offers the least chance of recurrence.

Methods

Outcomes of an islanded fasciocutaneous internal mammary artery perforator flap applied for tracheoesophageal fistula management were assessed in four radiated patients with laryngeal carcinoma using retrospective records.

Results

Four male patients, with an average age of 60.75 years, underwent tracheoesophageal fistula closure between September 2017 and February 2021. A left-sided second internal mammary artery perforator flap was used in all cases, with an average dimension of 10.5 × 4.5 cm. There were no complications of tracheoesophageal leak, flap issues or donor site morbidity on follow up.

Conclusion

Recent advances in angiosomal territory mapping and microvascular dissection techniques, combined with an understanding of tracheoesophageal fistula pathology, have changed management perspectives in these difficult-to-treat patients.

Keywords

Cancerhead and neck surgeryhead and neck canceresophagusradiotherapyoncologypharynxtrachea
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 6 , June 2024 , pp. 652 - 655
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Amrita Kaur takes responsibility for the integrity of the content of the paper

References

Kim, HS, Khemasuwan, D, Diaz-Mendoza, J, Mehta, AC. Management of tracheo-oesophageal fistula in adults. Eur Respir Rev 2020;29:200094CrossRefGoogle ScholarPubMed
Morimatsu, Y, Yonezawa, K, Matsui, H, Iwae, S, Sakakibara, S. Closing an intractable tracheoesophageal fistula caused by a tracheoesophageal shunt using a myocutaneous flap and a hinged flap with skin graft in a two-step procedure. Cureus 2021;13:e15913Google Scholar
Asarian, A, Esan, O, Adeoye, S. Esophagobronchial fistula complicating isolated esophageal Crohn's: a case report. J Med Cases 2014;5Google Scholar
Herth, FJ, Peter, S, Baty, F. Combined airway and oesophageal stenting in malignant airway – oesophageal fistulas: a prospective study. Eur Respir J 2010;36:1370–4CrossRefGoogle ScholarPubMed
Fukumoto, Y, Matsunaga, T, Shishido, Y, Amisaki, M, Kono, Y, Murakami, Y et al. Successful repair using thymus pedicle flap for tracheoesophageal fistula: a case report. Surg Case Rep 2018;4:4910.1186/s40792-018-0458-8CrossRefGoogle ScholarPubMed
Koshima, I, Soeda, S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42:645–8CrossRefGoogle ScholarPubMed
Vesely, M, Murray, DJ, Novak, CB, Gullane, PJ, Neligan, PC. The internal mammary artery perforator flap: an anatomical study and a case report. Ann Plast Surg 2007;58:156–61CrossRefGoogle ScholarPubMed
Murono, S, Ishikawa, E, Nakanishi, Y, Endo, K, Kondo, S, Wakisaka, N et al. Closure of tracheoesophageal fistula with prefabricated deltopectoral flap. Asian J Surg 2016;39:243–6CrossRefGoogle ScholarPubMed
Marsden, N, Shukla, L, Grinsell, D. Case report: revisiting the internal mammary artery perforator flap: salvage option for circumferential pharyngo-esophageal defects. Front Surg 2021;8:638345CrossRefGoogle ScholarPubMed
Schellekens, P, Hage, JJ, Paes, EC, Kon, M. The internal mammary artery perforator pedicled island flap for reconstruction of the lower head and neck and supraclavicular region: how we do it. Clin Otolaryngol 2010;35:332–610.1111/j.1749-4486.2010.02171.xCrossRefGoogle ScholarPubMed
Joseph, J. Nasal Plastic Surgery and Other Facial Reconstructive Procedures, with an Appendix on Reconstructive Breast Surgery and Some Other Procedures in the Area of External Plastic Surgery. Leipzig: Curt Kabitzsch, 1931Google Scholar
Conley, JJ. The use of regional flaps in head and neck surgery. Ann Otol Rhinol Laryngol 1960;69:1223–34CrossRefGoogle ScholarPubMed
Bakamjian, VY. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg 1965;36:173–84CrossRefGoogle ScholarPubMed
Yu, P, Roblin, P, Chevray, P. Internal mammary artery perforator (IMAP) flap for tracheostoma reconstruction. Head Neck 2006;28:723–910.1002/hed.20386CrossRefGoogle ScholarPubMed
Schellekens, PPA, Paes, EC, Hage, JJ, van der Wal, MBA, Bleys, RL, Kon, M. Anatomy of the vascular pedicle of the internal mammary artery perforator (IMAP) flap as applied for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2011;64:53–710.1016/j.bjps.2010.03.054CrossRefGoogle ScholarPubMed
Palmer, GH, Taylor, GI. The vascular territories of the anterior chest wall. Br J Plast Surg 1986;39:287–9910.1016/0007-1226(86)90037-8CrossRefGoogle ScholarPubMed
Mirghani, H, Leymarie, N, Amen, F, Qassemyar, Q, Leclère, FM, Kolb, F. Pharyngo tracheal fistula closure using the internal mammary artery perforator island flap. Laryngoscope 2014;124:1106–11CrossRefGoogle Scholar