PMC7324681_01
The manifestation of surgery and bronchoscopic images. (A) The tracheocutaneous fistula (TCF) measured 2.0 cm x 1.0 cm on the skin to the right side edge of the trachea. (B,C) Bronchoscopy revealed a fistula on the right wall of the tracheal, ~1 cm below the glottis, with an area of ~3.0 cm x 1.0 cm. It caused the dynamic compression of the lumen when it was sucked inwards at inspiration (Blue arrow). Black arrow showed trachea lumen. (D) The TCF was blocked by the covered airway stent. (E) The black arrow showed the airway stent waiting for the cover by the turnover flap. (F) The blue arrow showed that the degradable materials were vertically fixed to the grafting flap on the trachea. (G) Completion of the flap grafting. (H) Repeated bronchoscopy examination 12 months later showed that the anastomosis healed well from the inside view of the trachea lumen without constriction or dynamic stenosis.
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F1
TCF had developed. The stoma measured 2.0 cm x 1.0 cm on the skin to the right side of the trachea (Figure 1A). Bronchoscopy revealed a fistula on the right side of the tracheal wall, ~1 cm below the glottis, with an area of ~3.0 cm x 1.0 cm in size (Figures 1B,C). Internal coverage of the entire defect by the tracheal stent was confirmed by flexible bronchoscopy (Figure 1D). The tracheal layer was sutured with interrupted 4-0 Vicryl rigorously (Figure 1E). Ventilation was maintained during stent implantation and fistula resection and reconstruction (Figure 1G). Mucosal epithelial metaplasia occurred in the lumen with no constriction or dynamic stenosis of the trachea (Figure 1H).
The repeated three-dimensional computed tomography (3D-CT) of the trachea and the spirometry at 16-month follow-up. (A) There was partial absence at the right side of the trachea on the 3D-CT on admission (Red arrow pointed to the fistula). (B) The repeated CT at 16-month follow-up showed that the fistula was covered by the flap grafting (Red arrow). (C) The spirometry at 16-month follow-up showed that the ventilatory function was normal. (D) The flow-volume loop showed that no fixed or dynamic airway obstruction existed. Good patency and stableness of large airway was maintained after the treatment.
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F2
The 3D-CT of trachea showed recovery of the TCF, and the spirometry was normal which indicated no fixed or dynamic airflow limitation and the maintain of the patency and stableness of the large airways at the 16-month follow-up (Figure 2).