Closure of Tracheoesophageal Fistula Using Sternocleidomastoid Muscle Flap: A Case Report

Ohno Keiko, Kimura Yurika, Takahashi Masatoki, Miwa Koh, Honjyou Motomu, Nishio Ayako, Kishimoto Seiji

doi:10.2468/jbes.69.33

<p>Tracheoesophageal fistula (TEF) is a rare but life-threatening complication associated with tracheostomy. We report a case of TEF after tracheostomy which successfully closed using the sternocleidomastoid muscle flap. A 68-year-old woman underwent tracheostomy after thoracotomy for acute myocardial infarction at another hospital 5 months previously. Two months later, she began to report dysphagia and underwent a gastrostomy. Because of repeated aspiration pneumonia, she visited our hospital by introduction. Videofluorographic examination of swallow and bronchoscopy detected TEF. We performed surgical closure of the fistula, as follows. We identified and divided the fistula and sutured the esophageal and tracheal defects ; the sternocleidomastoid muscle flap was then translocated to between the trachea and esophagus so as to cover the site of the sutures. The patient started swallowing training on the 11th postoperative day, was discharged from hospital on the 20th postoperative day, and can now eat normal food. TEF has not recurred and the gastrostoma was removed. In the present case, we believe that TEF was caused by a tracheal cuff leading to pressure necrosis and/or an injury due to the repeated intubation of the tracheotomy tube.</p>

Closure of Tracheoesophageal Fistula Using Sternocleidomastoid Muscle Flap: A Case Report

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