Platelet-Rich Plasma for Non-Invasive Closure of Tracheal and Bronchial Fistulas: A Case Series

Abstract Background Airway fistulas remain life-threatening complications following thoracic surgery or prolonged mechanical ventilation. Conventional treatments are mainly invasive and associated with significant morbidity. Platelet-rich plasma (PRP), an autologous platelet concentrate with regenerative and immunomodulatory properties, has recently been explored as a minimally invasive therapeutic option; however, its use in airway fistulas remains experimental. Case Presentation We report two high-risk patients: a 58-year-old male who developed a tracheoesophageal fistula (TEF) after prolonged intubation with a size 8.0 mm endotracheal tube for severe pneumonia and septic shock, and a 65-year-old female with a post-lobectomy bronchopleural fistula (BPF) following surgery for bronchiectasis. Both patients were unsuitable for surgical repair due to poor physiological reserve and high perioperative risk. Endoscopic autologous PRP prepared using a double-centrifugation protocol was injected circumferentially around the fistulous openings in two sessions at 2-week intervals. Results Complete fistula closure was achieved in both cases, confirmed by bronchoscopy and computed tomography. No procedure-related complications occurred. Clinical recovery was sustained at 3-month follow-up. Conclusion Endoscopic PRP injection may represent a feasible minimally invasive alternative for selected high-risk patients with airway fistulas. Its regenerative, pro-angiogenic and immunomodulatory properties provide biological plausibility for its therapeutic use. Prospective clinical trials are needed to validate safety and efficacy. Learning Point In elderly or physiologically fragile patients with impaired immune and inflammatory responses, autologous PRP can provide exogenous immune support and anti-inflammatory modulation and facilitate airway tissue repair when conventional surgical options are inappropriate.