INTERCOSTAL MUSCLE FLAP IN MANAGING RECCURENT TEF

1. Intercostal muscle flap an easy adjunct in
repair of recurrent Tracheoesophageal
Fistula and complex fistula.
Dr.Dony Devasia
Prof.Naveen Viswanath
Dr.Pramod.R.Pillai

2. To evaluate the usefulness of intercostal muscle flaps in reducing
postoperative complications in recurrent and complex Tracheoesophageal
fistula.
AIM:

3. Introduction:
• Recurrent tracheoesophageal fistula (rTEF) is a diagnostic and
surgical challenge
• Incidence is 3–14% of EA/TEF repairs .
• By reviewing a single institution's experience in the management
of rTEF and assessing the outcome, we aimed to provide an
optimal approach for managing rTEF.

4. TOTAL No OF CASES
4 Recurrent TEF
Surgery elsewhere
1 LARGE TEF
BUTTON BATTERY
DIAGNOSIS CONFIRMED BY
BRONCHOSCOPY..
RIGHT POST- LAT THORACOTOMY..
REINFORCEMENT OF SUTURE LINE
 IC MF
Methods:

7. • Later a reinforcement with an intercostal muscle flap based on
posterior intercostal artery is retrieved.
• Right sided chest cavity was approached through fifth intercostal
space and an intercostal muscle pedicle based on posterior
intercostals artery was isolated .
• An intercostal muscle flap is a versatile pedicle flap that can reach
all bronchi. It is easy to harvest, adds no morbidity, and may
protect the trachea at risk.

12. Results:
• This is a single centre, follow up study conducted in a tertiary
care centre from October 2021 to July 2022.
• Aged between 1 year 9 months and to 4 years.
• Body weight 5.07 kg to 11.5kg.
• Three out of 5 cases had leak from esophageal repair site - all were
managed conservatively.
• Oesophageal leak typically occurred on Day 7 or 8 postoperatively.
• The leak stopped over a week’s time and was confirmed by an upper
GI contrast study before removing the chest drain.

13. • All these children started gaining weight with no further
respiratory complications and are tolerating oral feeds.
• Three out of 5 patients developed esophageal stricture -
which was managed with endoscopic dilatations alone.

14. Results:
• All the patients could be extubated on table
• None of the children had respiratory complications including
pneumonia.
• Nasogastric feeds on Day 4. None of these patients had recurrent TEF
even though 3 had leak from esophageal end which could be managed
conservatively.

15. • Discussion:
• ICMuscle flap is flap that can be easily raised by a pediatric
surgeons.
• Latissimus dorsi or the serratus anterior, are associated with
morbidity and in small children can cause extrinsic compression to
trachea and esophagus due to its bulk.
• Intercostal muscle flaps provides vascularised tissue in between
the two suture lines.
• Since the pleura is too thin and the pericardial fat pad is inconsistent
and has unreliable bloodsupply we have come to prefer the intercostal
muscle(ICM) flap.

16. Conclusions:
• Vascular intercostal muscle flap is a technically easy adjunct in
redo and complex TEF,It helps in reducing the respiratory
complications post surgery.
• The respiratory outcome was excellent in all these 5 cases with no
recurrence of trachea oesophageal fistulae.
• Since the number of cases studied are very small and follow up is
limited, further study with long term follow up is needed to
confirm the effectiveness of this technique in the management of
children with recurrent TEF.

17. THANKYOU