title: A more conservative technique for anterior mediastinal tracheostomy after sub-total resection of the trachea.
abstract: Anterior mediastinal tracheostomy (AMT) is a rare but challenging operation associated with a high morbidity and mortality rate mainly related to the invasiveness of the procedure. In order to provide a more conservative technique with a lower risk of major postoperative complications, we proposed: (1) to reduce the extent of chest wall resection to only a trapezoidal segment of the manubrium; (2) to use a simple pedicle pectoralis major flap instead of myocutaneous or omental flaps; and (3) to perform a simple relocation of the residual trachea (RT) below the brachiocephalic artery instead of artery ligation, percutaneous stent placement or replacement by cadaveric allograft. This technique was used in a patient with cancer recurrence at the cervical stoma after total laryngectomy. Despite a short 2.5-cm RT, it was possible to perform AMT without any tension at the mediastinal stoma. Postoperative course showed only regressive minor complications. There was no late complication related to the procedure with a one-year follow-up. This more conservative technique for AMT could be used as an alternative to previously described procedures in order to reduce postoperative complications and mortality rate after sub-total resection of the trachea.
authors.affiliation: Department of Hemato-Onco-Thorax, Unit of Thoracic and Vascular Surgery, Faculty of Medicine SMBH, Assistance Publique, Hôpitaux de Paris, CHU Paris, Seine Saint-Denis, Avicenne Hospital, Paris 13 University, Bobigny, Paris, France. emmanuel.martinod@avc.aphp.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Martinod
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Guillaume
authors.forename: Dana M
authors.initials: DM
authors.lastname: Radu
authors.forename: Gilles
authors.initials: G
authors.lastname: Despreaux
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005602:France; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local; D010369:Pectoralis Muscles / Q000601:surgery; D012086:Reoperation; D013524:Surgical Flaps; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome