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Complex Tracheocarinal Reconstructions Using Extrathoracic Muscle Flaps as Airway Substitutes.
Jeannine Blatter1, Thorsten Krueger1, Hans-Beat Ris1
1Division of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
The Annals of Thoracic Surgery
|February 11, 2018
Summary
Extrathoracic muscle flaps effectively reconstruct complex airway defects, offering a life-saving solution for tracheoesophageal fistulas and post-tumor resection cases. This technique demonstrates high success rates with manageable complications in airway reconstruction.
Area of Science:
- Thoracic Surgery
- Surgical Reconstruction
- Airway Management
Background:
- Complex airway defects, including bronchopleural and tracheoesophageal fistulas, pose significant surgical challenges.
- Tracheocarinal reconstructions are often necessary after central lung tumor resections to alleviate anastomotic tension.
Purpose of the Study:
- To evaluate the efficacy of extrathoracic muscle flaps as airway substitutes in tracheocarinal reconstructions.
- To assess complication rates and long-term outcomes of this surgical technique.
Main Methods:
- Retrospective evaluation of 73 patients undergoing tracheocarinal reconstructions with extrathoracic muscle flap patches between 1996 and 2016.
- Analysis of patient data including defect size, surgical indication, mortality, and complication rates.
Main Results:
- 73 patients underwent reconstruction for fistulas (n=24) or post-resection airway defects (n=50).
- Postoperative 90-day mortality was 8.2%, observed only after pneumonectomy.
- Airway complications occurred in 10% of patients (dehiscence 5%, stenosis 5%), with most requiring reoperation or stenting.
- 94% of surviving patients had intact airways without further interventions during follow-up.
Conclusions:
- Extrathoracic muscle flaps are a valuable option for closing complex tracheocarinal airway defects.
- This technique can effectively reduce anastomotic tension in challenging tracheocarinal surgeries.
- Muscle flaps offer a potentially life-saving solution for difficult airway reconstructions.
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