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.
Ris
Hans-Beat
HB
Division of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. hans-beat.ris@chuv.ch
Krueger
Thorsten
T
Cheng
Cai
C
Pasche
Philippe
P
Monnier
Philippe
P
Magnusson
Lennart
L
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