(0825) Outcomes and Management of Tracheocutaneous Fistula in Adults: A Systematic Review

Introduction: Tracheocutaneous fistula (TCF) is a potential complication following tracheostomy decannulation, particularly in the setting of long-term tracheostomy placement. TCF has been largely studied in the pediatric population, but limited literature exists on TCF in adults. This systematic review provides a comprehensive discussion of demographics, treatment modalities, and outcomes of adult patients post-TCF correctional surgery.

Methods: The PubMed and Embase databases were queried with the keywords “tracheocutaneous fistula.” Articles were selected if published between 1990 and 2023 and reported data related to patients aged ≥18 years old with TCF. Case studies and reviews were excluded. Participant demographics, comorbidities, treatment modalities, and outcomes were extracted.

Results: The database query identified 223 relevant abstracts, of which 10 studies met inclusion criteria. A total of 226 adults with TCF were identified with 60.4% male patients and a mean age of 55.4 years (range: 41-62.9). Tracheostomy duration ranged from 0.2-96 months. Overall, surgical treatment of TCF resulted in a success rate of 93.8% (n = 212) and a complication rate of 15% (n = 34). The most common complication was infection (7.1%, n = 16) followed by necrosis (2.7%, n = 6) and aspiration (1.3%, n = 3).

The various techniques for TCF closure included in this study were grouped into three general categories: Z-plasty (n = 38), simple advancement flap (n = 73), and rotational/hinge flap (n = 101). The success rates of these techniques were 100%, 96.1%, and 90.2%, respectively, and the complication rates were 21.1%, 3.9%, and 20.5%, respectively. Notably, 15.8% (n = 6) of Z-plasty patients experienced tissue necrosis and 11.6% (n = 13) of rotational/hinge flap patients experienced a postoperative infection.

Conclusions: There is a paucity of research describing the management and outcomes of adult patients with TCF. This review suggests that simple advancement flap may be the best treatment option for TCF closure in adults due to its favorable success and complication rates, however, more research is necessary.