title: A new technique for treatment of tracheal compression by the innominate artery: external reinforcement with autologous cartilage graft and muscle flap suspension.
abstract: We report a new technique for treatment of tracheomalacia or tracheal compression caused by the innominate artery, utilized in two patients with neuromuscular disorders. Both cases developed a chest deformity in the setting of severe scoliosis. Computed chest tomography and fiberoptic bronchoscopy showed that the cervical trachea was compressed between the innominate artery and the cervical spine in the setting of deformity of the thoracic cavity. Both patients required prolonged mechanical ventilation prior to the operative procedure. To relieve compression by the innominate artery, the superior mediastinum was exposed by resection of part of the manubrium allowing a greater space, and external stenting of the cervical trachea with a reinforcing autologous cartilage graft and tracheopexy, as well as anterior suspension of the innominate artery with a sternohyoid muscle flap were carried out. Both patients were successfully weaned from prolonged mechanical ventilation. Resection of the manubrium sterni, tracheal stenting with rib segments and use of the strap muscle to elevate the innominate artery off of the trachea offer potential long-term release of airway obstruction.
authors.affiliation: Department of Pediatric Surgery, Graduate School of Comprehensive Human Sciences and University Hospital, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan. tatekawa3966@s5.dion.ne.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Tatekawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Tojo
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hori
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Komuro
authors.forename: Yashuhisa
authors.initials: Y
authors.lastname: Urita
authors.forename: Sumi
authors.initials: S
authors.lastname: Kudou
authors.forename: Michio
authors.initials: M
authors.lastname: Kaneko
mesh_terms: D000293:Adolescent; D016122:Brachiocephalic Trunk / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D005260:Female; D006801:Humans; D009132:Muscles; D012600:Scoliosis / Q000150:complications*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014135:Tracheal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome