Objective1) Describe a novel, 3‐stage approach to closure of a large tracheocutaneous fistula (TCF) and augmentation of an adjacent area of tracheal stenosis. 2) Present pre‐, intra‐, and postoperative photographs to illustrate surgical technique. 3) Discuss postoperative patient care considerations. 4) Review other techniques described for similar defects.MethodCase report of patient receiving treatment from May 2010 to present. The patient presented with a 1.4 by 1.6 cm TCF and adjacent tracheal stenosis. This was repaired in a 3‐stage approach culminating in radial forearm free flap (RFFF) with banked conchal cartilage and buccal mucosal graft for tracheal closure.ResultsThis case resulted in successful closure of a 1.4 by 1.6 cm TCF in a previously radiated patient using a novel, 3‐stage approach. The initial stage involved implanting a conchal cartilage graft in the left radial forearm. During the second stage a buccal mucosal graft was implanted to cover the conchal cartilage graft after removing the hair‐baring skin. The third stage involved transfer of the RFFF with cartilage and mucosal graft for closure of the TCF, augmenting the support with an absorbable miniplate. The patient had no issues with breathing, speaking, or wound healing immediately or at four months postoperative.ConclusionLarge TCFs in irradiated patients present a unique surgical challenge. This case illustrates successful closure of an extensive TCF involving anterior trachea and partial bilateral sidewalls. The unique graft allowed for structural support with hairless mucosal lining on a fasciocutaneous flap.

Free accessAbstractFirst published online August 2010Facial Nerve Localization: Is Triangulation the Key?Mark Royer, MD, presenter, Michael Moore, MD, […], Susan Cordes, MD, Edward Weisberger, MD, and Mimi Kokoska, MD, +2 -2Volume 143, Issue 2_supplhttps://doi.org/10.1016/j.otohns.2010.06.283

Otolaryngology–Head and Neck SurgeryVolume 143, Issue S2 p. P172-P172 Poster Presentation Recurrent Laryngeal Nerve Branching: Modern Relevance Mark Royer MD, Mark Royer MD presenterSearch for more papers by this authorMichael Moore MD, Michael Moore MDSearch for more papers by this authorStacey Halum MD, Stacey Halum MDSearch for more papers by this authorMimi Kokoska MD, Mimi Kokoska MDSearch for more papers by this author Mark Royer MD, Mark Royer MD presenterSearch for more papers by this authorMichael Moore MD, Michael Moore MDSearch for more papers by this authorStacey Halum MD, Stacey Halum MDSearch for more papers by this authorMimi Kokoska MD, Mimi Kokoska MDSearch for more papers by this author First published: 20 June 2017 https://doi.org/10.1016/j.otohns.2010.06.306Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume143, IssueS2August 2010Pages P172-P172 RelatedInformation