PMC5120373_01
Tracheocutaneous fistula. (a) Preoperative photograph. (b) Computed tomographic scan showing a tracheocutaneous fistula of 15 x 20 mm.
eplasty16e30_fig1.jpg
PMC5120373_01_eplasty16e30_fig1.jpg
F1
Prolonged intubation left a tracheal wall defect measuring 15 x 20 mm just above the sternal notch (Fig 1a). Since preoperative computed tomography showed no stenosis or obstruction of the trachea, we decided to simply cover the defect without carrying out a procedure to enlarge the trachea (Fig 1b), and resurfacing the inner lumen of the trachea with mucosa to facilitate her expectorating was planned.
First operation. (a) Schematic drawing of the first operation. Palatal mucosa was grafted just below the orifice of the fistula. Resected skin from the recipient site of the mucosal graft was grafted on the donor site of the palatal mucosa. Gray rectangles indicate skin and mucosal grafts. (b) Mucosal graft measuring 15 x 20 mm.   indicates endotracheal tube.
eplasty16e30_fig2.jpg
PMC5120373_01_eplasty16e30_fig2.jpg
F2
Tie-over gauze was fixed on both grafts (Fig 2).
Second operation. (a) Mucosal graft and flap design (solid line) at the second operation. Skin adjoining the mucosal graft is de-epithelialized. Triangular skin outside of the flap (dotted line) is resected to close the wound to a straight line. (b) De-epithelialized flap carrying the mucosal graft (green arrows) is turned over and sutured to the peristomal hinge flap facing the mucosal graft inward.   indicates endotracheal tube. (c) Schematic drawing of the flap.
eplasty16e30_fig3.jpg
PMC5120373_01_eplasty16e30_fig3.jpg
F3
A rectangular flap measuring 45 x 20 mm containing the mucous graft in the middle of the flap was designed, and the skin beside the pregrafted mucosa was de-epithelialized (Fig 3).