Surgical treatment of recurrent tracheo-esophageal fistula using a latissimus dorsi pedicled muscle flap--report of a case.

Abstract

We report herein, a case of a child in whom a prepared latissimus dorsi muscle flap was successfully utilized in the treatment of recurrent tracheo-esophageal fistula (TEF). A 12-month-old girl who had undergone a primary repair of Gross's type C esophageal atresia at 6 days of age and a secondary repair of recurrent TEF at 4 months of age experienced, postoperatively, repeated episodes of aspiration pneumonia caused by recurrence of the fistula. Thus, we performed a reoperation in which the fistula was excised, and a latissimus dorsi muscle pedicled flap was interposed between the tracheal and esophageal suture lines. Viability of the muscle flap was adequately achieved by means of a three-stage delayed operation. Although a minor anastomotic leakage of the esophagus was found postoperatively, it healed spontaneously, and the patient was commenced on a normal diet orally without any problems at 26 months of age.