Tracheo-carinal reconstructions using extrathoracic muscle flaps.

Details

Ressource 1Download: serval:BIB_DDD827A89EF7.P001 (461.17 [Ko])
State: Public
Version: author
License: Not specified
It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.
Serval ID
serval:BIB_DDD827A89EF7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Tracheo-carinal reconstructions using extrathoracic muscle flaps.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Ris H.B., Krueger T., Cheng C., Pasche P., Monnier P., Magnusson L.
ISSN
1010-7940 (Print)
ISSN-L
1010-7940
Publication state
Published
Issued date
2008
Peer-reviewed
Oui
Volume
33
Number
2
Pages
276-283
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article
Publication Status: ppublish
Abstract
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 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.
Keywords
Adolescent, Adult, Aged, Bronchial Fistula/surgery, Female, Humans, Male, Middle Aged, Prospective Studies, Reoperation, Respiratory Tract Fistula/surgery, Surgical Flaps, Surgical Procedures, Operative/adverse effects, Surgical Procedures, Operative/methods, Surgical Wound Dehiscence/surgery, Suture Techniques, Trachea/injuries, Trachea/surgery, Tracheal Diseases/surgery, Tracheal Neoplasms/surgery, Tracheoesophageal Fistula/surgery
Pubmed
Web of science
Open Access
Yes
Create date
28/02/2008 13:44
Last modification date
25/09/2019 7:11
Usage data