PMC10172662_01
(A) Fascia lata harvesting with skin and subcutaneous tissue; (B) fascia lata graft after skin removal with subcutaneous fat tissue.
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F1
Urgent bronchoscopy was performed showing a roughly 3 cm x 1 cm TEF superior to the carina with the esophageal stent protruding into the tracheal lumen (Figure 1). A 5 cm long incision was performed along the lateral aspect of the caudal part of the thigh and a fascia lata graft of roughly 7 cm x 3 cm and 6 mm in thickness with subcutaneous fat tissue was harvested to obtain sufficient graft thickness (Figure 1).
Intraoperative bronchoscopic procedure. (A) Rigid bronchoscopy showing TEF with esophageal stent protruding inside tracheal lumen in two different sites (red arrows); (B) TEF margins freshened using aspirator; (C) positioning of fascia lata (red arrow) over TEF with forceps; (D) tracheal stent correctly positioned over fascia lata graft.
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F2
A silicone tracheal stent (NOVATECH Dumon stents, ST 18-16-18 L 15-20-15, Boston Medical Products, Inc., Westborough, MA, USA) was placed to maintain the fascia lata graft in place allowing to cover TEF site both cranially and caudally (Figure 2).
(A) Postoperative barium videofluoroscopy showing contrast medium passing regularly passing through the esophagus without signs of aspiration through the site of TEF. (B) EGDS performed after 7 months showing esophageal stent in place with fascia lata adipose tissue inside interstices (black arrows).
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F3
EGDS were performed after 7 months showing no signs of TEF patency. EGDS showed esophageal stent and fascia lata in place (Figure 3) with the patient maintaining oral feeding without any weight loss or aspiration symptoms or signs.