Tracheo-carinal reconstructions using extrathoracic muscle flaps.

Tracheo-carinal reconstructions using extrathoracic muscle flaps. Research Abstract Details 

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Tracheo-carinal reconstructions using extrathoracic muscle flaps. Abstract Text:

Hans-Beat Ris,Thorsten Krueger,Cai Cheng,Philippe Pasche,Philippe Monnier,Lennart Magnusson,Hans-Beat Ris,Thorsten Krueger,Cai Cheng,Philippe Pasche,Philippe Monnier,Lennart Magnusson,

Objectives: 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 2x1cm to 8x4cm 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.

Tracheo-carinal reconstructions using extrathoracic muscle flaps. Publishing Authors By Initials

HB Ris,T Krueger,C Cheng,P Pasche,P Monnier,L Magnusson,HB Ris,T Krueger,C Cheng,P Pasche,P Monnier,L Magnusson,

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Tracheo-carinal reconstructions using extrathoracic muscle flaps. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: European journal of cardio-thoracic surgery : offi

VOLUME: 33

Page Numbers: 276-83

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ISSN: 1010-7940

DAY: 4

MONTH: 12

YEAR: 2007

Tracheo-carinal reconstructions using extrathoracic muscle flaps. Information

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LANGUAGE: eng

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Grant and Affiliation Information for Tracheo-carinal reconstructions using extrathoracic muscle flaps.

AFFILIATION: Division of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Country: Germany

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MEDLINETA: Eur J Cardiothorac Surg

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