Tracheo-carinal reconstructions using extrathoracic muscle flaps.
OBJECTIVE
Prospective evaluation of tracheo-carinal airway reconstructions using pedicled extrathoracic muscle flaps for closing airway defects after non-circumferential resections and after carinal resections as part of the reconstruction for alleviation of anastomotic tension.


METHODS
From January 1996 to June 2006, 41 patients underwent tracheo-carinal airway reconstructions using 45 extrathoracic muscle flaps (latissimus dorsi, n=25; serratus anterior, n=18; pectoralis major, n=2) for closing airway defects resulting from (a) bronchopleural fistulas (BPF) with short desmoplastic bronchial stumps after right upper lobectomy (n=1) and right-sided (pleuro) pneumonectomy (n=13); (b) right (n=9) and left (n=3) associated with partial carinal resections for pre-treated centrally localised tumours; (c) partial non-circumferential tracheal resections for pre-treated tracheal tumours, tracheo-oesophageal fistulas (TEF) and chronic tracheal injury with tracheomalacia (n=11); (d) carinal resections with the integration of a muscle patch in specific parts of the anastomotic reconstruction for alleviation of anastomotic tension (n=4). The airway defects ranged from 2 x 1 cm to 8 x 4 cm and involved up to 50% of the airway circumference. The patients were followed by clinical examination, repeated bronchoscopy, pulmonary function testing and CT scans. The minimum follow-up time was 6 months.


RESULTS
Ninety-day mortality was 7.3% (3/41 patients). Four patients (9.7%) sustained muscle flap necrosis requiring re-operation and flap replacement without subsequent mortality, airway dehiscence or stenosis. Airway dehiscence was observed in 1/41 patients (2.4%) and airway stenosis in 1/38 surviving patients (2.6%) responding well to topical mitomycin application. Follow-up on clinical grounds, by CT scans and repeated bronchoscopy, revealed airtight, stable and epithelialised airways and no recurrence of BPF or TEF in all surviving patients.


CONCLUSIONS
Tracheo-carinal airway defects can be closed by use of pedicled extrathoracic muscle flaps after non-circumferential resections and after carinal resections with the muscle patch as part of the reconstruction for alleviation of anastomotic tension.
Division of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. hans-beat.ris@chuv.ch
Hans-Beat
HB
Ris
Thorsten
T
Krueger
Cai
C
Cheng
Philippe
P
Pasche
Philippe
P
Monnier
Lennart
L
Magnusson
D000293:Adolescent; D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000601:surgery*; D013524:Surgical Flaps; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013536:Suture Techniques; D014132:Trachea / Q000293:injuries / Q000601:surgery; D014133:Tracheal Diseases / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000601:surgery