Interposition of the thymus as a pedicled flap in tracheal reconstructive surgery

Thymus was interposed in six patients following tracheal reconstruction: three tracheo-innominate fistula repairs, two resections for stenosis, and one repair of a membranous tear during esophagectomy. The two resections for stenosis were elective; the others were emergent repairs. This gland, readily accessible in the upper mediastinum, is easily dissected from the pleura and pericardium and separated into two lobes. Pedicles based at the thoracic inlet measure between 15 and 20 cm by 4 cm. Each lobe receives independent arterial blood supply and venous drainage which remains intact even if the innominate vein must be divided to effect tracheal repair. All patients survived the perioperative period. The patient with the tracheo-innominate fistula died 1 month later. No patient had evidence of further vascular complications or tracheal anastomotic leak even though one patient developed a long segment of necrotic trachea. Reinforcement following tracheal reconstruction is important in preventing complications from anastomotic leak or vascular erosion. The pedicled thymus gland is an excellent, readily available interposition flap for emergent or elective tracheal reconstruction.