Combined free autologous auricular cartilage and fascia lata graft repair for a recurrent tracheoesophageal fistula
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TECHNICAL INNOVATION
Combined free autologous auricular cartilage and fascia lata graft repair for a recurrent tracheoesophageal fistula Akihide Sugiyama • Naoto Urushihara • Koji Fukumoto • Hiroaki Fukuzawa • Kentaro Watanabe • Maki Mitsunaga Takeshi Aoba • Susam Park
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Accepted: 18 December 2012 / Published online: 5 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Repair of recurrent tracheoesophageal fistula (TEF) after repair of congenital esophageal atresia continues to be a difficult problem. The most common re-operation for a recurrent TEF involves repair via a right thoracotomy and use of a flap as interposed tissue between the closure sites. Although several materials have been reported for recurrent fistula repair, natural pedicled flaps have been used in most previous reports. The harvesting of a pedicled flap can sometimes be difficult when the patient has had multiple surgeries. In this report, the successful use of a combined free autologous auricular cartilage and free fascia lata graft repair for a complex patient with multiple recurrent TEFs is described. We believe that our technique should be considered as an approach for patients with recurrent TEF. Keywords Tracheoesophageal fistula Recurrence Fascia lata Auricular cartilage Congenital esophageal atresia
and perhaps the most vexing problem [1, 2]. Standard treatment involves repair via a right lateral thoracotomy and use of a flap as interposed tissue between the sutured trachea and esophagus to prevent further recurrence [3, 4]. It is traditionally done using a natural pedicled flap such as pleura, pericardium, intercostal muscle, omentum, or cervical muscle [3, 5, 6]. However, it is not always possible. The harvesting of a pedicled flap can sometimes be difficult due to adhesions at the surgical area when the patient has had multiple surgeries. In this report, the successful use of a combined free autologous auricular cartilage and free fascia lata graft repair for a complex patient who had repeated neck and thoracic surgeries with multiple recurrent TEFs is described. To the best of our knowledge, this is the first report of using an auricular cartilage and fascia lata graft for a recurrent TEF repair in pediatric patient.
Introduction
Case report
Recurrent tracheoesophageal fistula (TEF) is a common complication of congenital esophageal atresia (EA) repair
At 39 weeks’ gestation, a female infant weighing 2,480 g was delivered by normal vaginal delivery and diagnosed soon after birth as having an EA and a distal TEF. Primary repair of the EA with fistula division and an esophageal anastomosis under some tension via a right retropleural approach and gastrostomy were performed on the first day after birth in another hospital. Following surgery, no anastomotic leakage was observed. Other anomalies included coarctation of the aorta, patent ductus arteriosus (PDA), ventricular septal defect (VSD), and a laryngotracheo-esophageal cleft (LTEC) type I. Ligation of the PDA, pulmonary artery banding, and aortoplasty were
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