Closure of large intrathoracic airway defects using extrathoracic muscle flaps.
BACKGROUND
Prospective assessment of pedicled extrathoracic muscle flaps for the closure of large intrathoracic airway defects after noncircumferential resection in situations where an end-to-end reconstruction seemed risky (defects of > 4-cm length, desmoplastic reactions after previous infection or radiochemotherapy).


METHODS
From 1996 to 2001, 13 intrathoracic muscle transpositions (6 latissimus dorsi and 7 serratus anterior muscle flaps) were performed to close defects of the intrathoracic airways after noncircumferential resection for tumor (n = 5), large tracheoesophageal fistula (n = 2), delayed tracheal injury (n = 1) and bronchopleural fistula (n = 5). In 2 patients, the extent of the tracheal defect required reinforcement of the reconstruction by use of a rib segment embedded into the muscle flap followed by temporary tracheal stenting. Patient follow-up was by clinical examination bronchoscopy and biopsy, pulmonary function tests, and dynamic virtual bronchoscopy by computed tomographic (CT) scan during inspiration and expiration.


RESULTS
The airway defects ranged from 2 x 1 cm to 8 x 4 cm and involved up to 50% of the airway circumference. They were all successfully closed using muscle flaps with no mortality and all patients were extubated within 24 hours. Bronchoscopy revealed epithelialization of the reconstructions without dehiscence, stenosis, or recurrence of fistulas. The flow-volume loop was preserved in all patients and dynamic virtual bronchoscopy revealed no significant difference in the endoluminal cross surface areas of the airway between inspiration and expiration above (45 +/- 21 mm(2)), at the site (76 +/- 23 mm(2)) and below the reconstruction (65 +/- 40 mm(2)).


CONCLUSIONS
Intrathoracic airway defects of up to 50% of the circumference may be repaired using extrathoracic muscle flaps when an end-to-end reconstruction is not feasible.
Meyer
Antoine J H
AJ
Thoracic Surgery Unit, University of Lausanne, Switzerland.
Krueger
Thorsten
T
Lepori
Domenico
D
Dusmet
Michael
M
Aubert
John-David
JD
Pasche
Philippe
P
Ris
Hans-Beat
HB
D000293:Adolescent; D000328:Adult; D000368:Aged; D001982:Bronchial Diseases / Q000601:surgery*; D001983:Bronchial Fistula / Q000601:surgery; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008175:Lung Neoplasms / Q000601:surgery; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010995:Pleural Diseases / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis; D012123:Pulmonary Ventilation / Q000502:physiology; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000293:injuries / Q000601:surgery; D014133:Tracheal Diseases / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000601:surgery; D016896:Treatment Outcome; D014584:User-Computer Interface; D014945:Wound Healing / Q000502:physiology