A Case of Tracheoesophageal Shunt Operation on the Skin

Abstract

Tracheoesophageal shunts performed after laryngectomy for voice acquisition are usually performed on the mucosa of the trachea. We herein report a case in which tracheoesophageal shunting was performed on the skin. The patient was a 67-year-old woman who underwent pharyngolaryngo-neck esophagectomy and free jejunum reconstruction for tracheal cancer. The dorsal side of the permanent tracheal foramen was covered by skin because of the need to remove a large area of the dorsal trachea. Thirteen months after the initial surgery, tracheoesophageal shunting was performed. The tracheoesophageal shunting procedure was performed using almost the same technique as for the mucosa, but a 4-mm skin incision was required when the last proboscis was pulled out toward the trachea. Wound infection developed, and the voice prosthesis was removed on postoperative day 23 because of deviation of the prosthesis from the lumen. Two months after the previous surgery, the patient underwent revision surgery. She was treated with intravenous antibiotics until the postoperative day 7 to prevent infection and discharged from the hospital without any signs of infection. At six months postoperatively, the voice prosthesis was stable and in place, and the patient was able to speak. Two points should be noted when performing tracheoesophageal shunt surgery on the skin: a skin incision is required, and strict postoperative wound infection control is necessary.