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Ann Thorac Surg 1987;43:539-543
© 1987 The Society of Thoracic Surgeons

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Articles

Mediastinal Tracheostomy

From the Divisions of Thoracic and Cardiovascular Surgery and Plastic and Reconstructive Surgery, Georgetown University Medical Center, Washington, DC

Accepted for publication August 25, 1986.

^* Address reprint requests to Dr. Gomes, Department of Surgery, Georgetown University Medical Center, 3800 Reservoir Rd, NW, Washington, DC 20007

Upper airway obstruction in primary or recurrent carcinomas of the head and neck extending into the mediastinum may demand surgical intervention despite severe technical difficulties in patients with tumors previously considered inoperable. In fact, many of these tumors may be operable and some perhaps curable.

A technique has been developed based in part on our experience with previously described procedures. A preliminary sternal split is used to demonstrate the extent of the mediastinal involvement as well as to provide enhanced exposure and proximal control of the great vessels. The pectoralis major muscle is used with a generous flap of overlying skin comprising nearly half of the anterior portion of the chest. A tracheostomy is then created in a fashion similar to the placement of a cardiac valvular prosthesis by creating a circular defect in the pectoralis major flap and suturing it to the tracheal remnant.

This technique offers a reasonably safe and reliable means of creating a low anterior mediastinal tracheostomy for tumors previously considered inoperable. The preliminary sternal split makes the procedure safer and easier to perform, and the use of a very large pectoralis major island flap allows for reliable closure of the resulting mediastinal and sternal defects.

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