Complex Tracheocarinal Reconstructions Using Extrathoracic Muscle Flaps as Airway Substitutes.
- Blatter J Division of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
- Krueger T Division of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
- Ris HB Division of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland. Electronic address: hans-beat.ris@chuv.ch.
- Baeriswyl M Division of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland.
- Lovis A Division of Pneumology, University Hospital of Lausanne, Lausanne, Switzerland.
- Zellweger M Division of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
- Gonzalez M Division of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
- Perentes JY Division of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
- 2018-02-11
Published in:
- The Annals of thoracic surgery. - 2018
Adolescent
Adult
Aged
Bronchial Fistula
Child
Female
Humans
Lung Neoplasms
Male
Middle Aged
Pleural Diseases
Reconstructive Surgical Procedures
Reoperation
Retrospective Studies
Surgical Flaps
Survival Rate
Tracheoesophageal Fistula
Treatment Outcome
Young Adult
English
BACKGROUND
Extrathoracic muscle flaps can be used as airway substitutes for the closure of complex bronchopleural or tracheoesophageal fistulas or in the context of tracheocarinal reconstructions after resection for centrally localized tumors in order to alleviate excess anastomotic tension.
METHODS
Evaluation of all patients undergoing tracheocarinal reconstructions with extrathoracic muscle flap patches as airway substitutes in our institution from 1996 to 2016.
RESULTS
A total of 73 patients underwent tracheocarinal reconstructions using extrathoracic muscle flap patches as airway substitutes for the closure of bronchopleural fistulas (n = 17) and complex tracheoesophageal fistulas (n = 7), or in the context of airway reconstructions after carinal resections in combination with pneumonectomy/sleeve lobectomy for centrally localized lung tumors (n = 36) and noncircumferential tracheal resections for tracheal disease processes (n = 14). The size of airway defects replaced by muscle patches ranged from 2 × 2 to 8 × 4 cm and was at most 40% of the airway circumference. The postoperative 90-day mortality was 8.2% and was only observed after right-sided pneumonectomy. Complications at the airway reconstruction site occurred in 8 patients (10%): 4 airway dehiscence (5%) with uneventful healing after reoperation (n = 2) or temporary stenting (n = 2) and 4 airway stenosis (5%) that required repeated bronchoscopy and stenting. Overall, 63 of 67 surviving patients (94%) revealed intact airways without further bronchoscopic interventions or tracheal appliance during follow-up.
CONCLUSIONS
Extrathoracic muscle flaps used as airway substitutes are an interesting and sometimes life-saving option to close difficult tracheocarinal airway defects or to reduce anastomotic tension in the context of complex tracheocarinal surgeries.
Extrathoracic muscle flaps can be used as airway substitutes for the closure of complex bronchopleural or tracheoesophageal fistulas or in the context of tracheocarinal reconstructions after resection for centrally localized tumors in order to alleviate excess anastomotic tension.
METHODS
Evaluation of all patients undergoing tracheocarinal reconstructions with extrathoracic muscle flap patches as airway substitutes in our institution from 1996 to 2016.
RESULTS
A total of 73 patients underwent tracheocarinal reconstructions using extrathoracic muscle flap patches as airway substitutes for the closure of bronchopleural fistulas (n = 17) and complex tracheoesophageal fistulas (n = 7), or in the context of airway reconstructions after carinal resections in combination with pneumonectomy/sleeve lobectomy for centrally localized lung tumors (n = 36) and noncircumferential tracheal resections for tracheal disease processes (n = 14). The size of airway defects replaced by muscle patches ranged from 2 × 2 to 8 × 4 cm and was at most 40% of the airway circumference. The postoperative 90-day mortality was 8.2% and was only observed after right-sided pneumonectomy. Complications at the airway reconstruction site occurred in 8 patients (10%): 4 airway dehiscence (5%) with uneventful healing after reoperation (n = 2) or temporary stenting (n = 2) and 4 airway stenosis (5%) that required repeated bronchoscopy and stenting. Overall, 63 of 67 surviving patients (94%) revealed intact airways without further bronchoscopic interventions or tracheal appliance during follow-up.
CONCLUSIONS
Extrathoracic muscle flaps used as airway substitutes are an interesting and sometimes life-saving option to close difficult tracheocarinal airway defects or to reduce anastomotic tension in the context of complex tracheocarinal surgeries.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.athoracsur.2018.01.021
- PMID 29427616
- Persistent URL
- https://sonar.rero.ch/global/documents/68316
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