A Novel Technique of Negative Pressure Wound Therapy for Pharyngeal Cutaneous Fistulas Around Tracheostomas.

ABSTRACT: Fistula formation after free jejunal transplantation is relatively common; however, treating esophago-jejunal anastomosis fistulas is difficult. Herein, the authors report a case of esophago-jejunal anastomosis fistula adjacent to the permanent tracheostoma after free jejunal transplantation that was closed using negative pressure wound therapy (NPWT). A 70-year-old man underwent total pharyngo-laryngo-cervical esophagectomy and free jejunal transplantation for hypopharyngeal cancer. After reconstruction, an esophago-jejunal anastomosis fistula developed on the permanent tracheostoma margin. The fistula was sutured, but it recurred. Therefore, NPWT was performed to close the fistula via the bridge method and balloon compression using a tracheal cannula. NPWT requires the maintenance of local negative pressure. However, esophago-jejunal anastomosis fistula formation after free jejunal transplantation makes this difficult because of the unevenness of the permanent tracheostoma and moist surface of the tracheal mucosa. NPWT performed using the bridge method and balloon compression is an effective option for fistula treatment.

Selection of Artificial Dermis for Shortening Treatment Period: Integra versus Pelnac.

Skin reconstruction of full-thickness skin defect wounds using artificial dermis is performed using secondary split-thickness skin grafting. For the selection of artificial dermis to shorten the treatment period, the waiting time until secondary skin grafting was investigated when the dermis-like tissue was constructed with Pelnac or Integra. METHODS: We evaluated 26 patients who underwent secondary skin grafting after dermis reconstruction with Pelnac (18 patients) or Integra (8 patients) for full-thickness skin defects between 2006 and 2017. The waiting period from artificial dermis application to closure of the full-thickness skin defect with a secondary skin graft was investigated retrospectively. RESULTS: Skin grafts survived well in all cases, and no complications of grafts or donors were observed. The mean waiting period was 17.5 ± 4.2 and 22.0 ± 4.6 days for the Pelnac and Integra groups, respectively (significantly shorter in the Pelnac group). CONCLUSIONS: The difference in waiting period is presumed to be due to the structural differences between the collagen sponge layer, which is the dermal replacement layer of Pelnac and Integra grafts. In cases where shortening the treatment period is important, Pelnac should be the first choice. In addition, in pediatric cases and widespread burns where it is difficult to control the infection during the waiting period, Pelnac is considered to be the first choice because the risk can be reduced by shortening the waiting period.

Successful management for repeated bar displacements after Nuss method by two bars connected by a stabilizer.

The Nuss method has become the standard surgery for the treatment of funnel chest, and good therapeutic results have been reported. Among the complications of the Nuss method, displacement of the bar is the most frequent, and there are cases in which reoperation is necessary. In this case report, we have devised a new stabilizer that connects and fixes two bars as bar displacement occurred following each of the two prior Nuss procedures, and the outcome of our procedure was evaluated.