Closed suction drains (Jackson- Pratt) usually are preferred. Broad-spectrum Trametinib antibiotics (usually a synthetic penicillin) are commenced and continued peri-operatively. The drains are left for a period of 5–7 days. Most surgeons recommend a contrast study before the removal of the drain, because of the frequent occurrence of fistula without clinical symptomatology. Nutritional support may be

delivered during this period by a nasogastric tube. Cervical oesophageal fistulas are reported in 10% to 28% of cases after oesophageal repair. The factors that contribute to this complication include inadequate debridement, oesophageal devascularization, tension on the learn more suture line and associated infection. Adequate drainage, exclusion of distal obstruction and maintenance of nutritional support are the cornerstones of fistula management and the majority of them heal with time [1, 5]. Combined tracheo-oesophageal injuries: Combined tracheo-oesophageal

trauma poses special problems: they are distinctly uncommon and thus may lead to management errors, they produce unique technical problems and may lead to complex complications in the remote postoperative period. Nearly always due to gun-shot injury, energy transfer; e.g., close range SGW vs. jacketed 32 caliber bullets determines the outcome. Feliciano and colleagues [3], based on an 11-year experience Sapanisertib of 23 patients, recommend the following principles: 1. the addition of tracheostomy to a simple

repair of the trachea may actually lead to a higher infectious morbidity in terms of pneumonia, mediastinal abscesses and wound infections. 2. For extensive oesophageal injuries in the cervical area, a cervical oesophagostomy, side or end, should be considered at the initial operation. Carbachol 3. Sternocleidomastoid or, preferably, strap muscle interposition should be employed between tracheal and oesophageal repairs as well as to cover carotid artery repairs. It must be remembered that the sternocleidomastoid has a segmental blood supply in thirds and the upper (from occipital artery) and the middle (from the superior thyroid artery) are more reliable for flap creation. And 4. Drainage of combined cervical injuries should be directed anteriorly and through the contralateral neck if a carotid artery injury is present. Injuries to the thoracic oesophagus Iatrogenic and trauma related perforations Non-operative management: A conservative, non-surgical approach occasionally is recommended for thoracic oesophageal perforations in selected patients. The perforation has to be contained for eligibility for non-operative management. Santos and Frater [8] described a system of “transoesophageal irrigation of the mediastinum” as a method of conservative management in patients with a delayed diagnosis of spontaneous rupture.