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Surgical management of combined cervical tracheo‐esophageal defects

Three rather complicated cervical tracheo‐esophageal problems and their appropriate management, are described. In each case, a tracheal defect required repair. In one case, fascia lata was used to close a defect in the posterior tracheal wall. In another, this type of repair was unsuccessful in one‐stage closure of a large tracheo‐esophageal fistula. A 7 cm defect of esophagus in heavily irradiated tissues was successfully reconstituted with transposed colon. The co‐existing postirradiation tracheo‐esophageal fistula was repaired at an earlier stage to ensure that the patient's recovery from the laparotomy would not be complicated by aspiration pneumonitis. Thoracotomy was not required, but resection of the clavicular head and mobilization of the origin of the sternomastoid were used to improve the transcervical exposure of the superior mediastinum.