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European Journal of Cardio-Thoracic Surgery, Vol 12, 351-355, Copyright © 1997 by European Association for Cardio-thoracic Surgery
FM Smolle-Juettner, G Pierer, F Schwarzl, H Pinter, B Ratzenhofer, G Prause and G Friehs
OBJECTIVE: In the presence of acute inflammation and necrosis of the wall,
tracheo-bronchial defects are difficult to manage. The absence of adequate
vascularization and the contaminated area prevent successful direct
re-suturing. METHODS: In order to restore a sufficient blood supply we used
a pedicled latissimus dorsi or a pectoralis major flap that was entered
into the thorax after a 10-cm resection of the second rib. A portion of the
muscle was fitted into the tracheo/bronchial defect by reinforced sutures.
The remaining muscle was sutured to the tissue surrounding the defect. This
method was applied in various septic conditions: Bronchial defects;
complete dehiscence of the right (n = 6) or left (n = 1) main bronchus at
the carinal level following resection for lung cancer (n = 4) or for
tuberculous (n = 2) on nontuberculous pleuropneumonia (n = 1). Tracheal
defects; (1) destruction of one third of the tracheal circumference
involving the cricoid down to the fourth ring following tracheotomy in
presence of a septic sternum after intrathoracic goiter and Bechterew's
disease; (2) 30% dehiscence of the anastomosis and septic sternum following
tracheal resection; (3) Mediastinitis involving tracheal and esophageal
wall following a 7 cm long iatrogenous laceration of the intrathoracic
trachea. RESULTS: In one case the latissimus dorsi developed venous stasis
on day 2 and was replaced by the pectoralis major muscle which showed
uneventful healing. In all other patients the muscle flap resulted in an
uneventful closure of the defect and recovery. CONCLUSIONS: Large, well
vascularized, pedicled muscle flaps ensure a safe closure of
tracheo-bronchial defects or dehiscences even in presence of gross necrosis
and sepsis.
ARTICLES
Life-saving muscle flaps in tracheobronchial dehiscence following resection or trauma
Department of Thoracic and Hyperbaric Surgery, University of Graz, Medical School, Austria.
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