HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael Dusmet Hans-Beat Ris Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Meyer, A. J. H. Articles by Ris, H.-B. Search for Related Content PubMed PubMed Citation Articles by Meyer, A. J. H. Articles by Ris, H.-B. Related Collections Trachea and bronchi

Ann Thorac Surg 2004;77:397-404
© 2004 The Society of Thoracic Surgeons

---

Original article: general thoracic

Closure of large intrathoracic airway defects using extrathoracic muscle flaps

^a Thoracic Surgery Unit, Lausanne, Switzerland
^b Department of Radiology, Lausanne, Switzerland
^c Division of Pulmonary Medicine, Lausanne, Switzerland
^d Department of Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland

Accepted for publication July 21, 2003.

^* Address reprint requests to Dr Ris, Thoracic Surgery Unit, CHUV, CH-1011 Lausanne, Switzerland
e-mail: hans-beat.ris{at}chuv.hospvd.ch

BACKGROUND: Prospective assessment of pedicled extrathoracic muscle flaps for the closure of large intrathoracic airway defects after noncircumferential resection in situations where an end-to-end reconstruction seemed risky (defects of > 4-cm length, desmoplastic reactions after previous infection or radiochemotherapy).

METHODS: From 1996 to 2001, 13 intrathoracic muscle transpositions (6 latissimus dorsi and 7 serratus anterior muscle flaps) were performed to close defects of the intrathoracic airways after noncircumferential resection for tumor (n = 5), large tracheoesophageal fistula (n = 2), delayed tracheal injury (n = 1) and bronchopleural fistula (n = 5). In 2 patients, the extent of the tracheal defect required reinforcement of the reconstruction by use of a rib segment embedded into the muscle flap followed by temporary tracheal stenting. Patient follow-up was by clinical examination bronchoscopy and biopsy, pulmonary function tests, and dynamic virtual bronchoscopy by computed tomographic (CT) scan during inspiration and expiration.

RESULTS: The airway defects ranged from 2x1 cm to 8x4 cm and involved up to 50% of the airway circumference. They were all successfully closed using muscle flaps with no mortality and all patients were extubated within 24 hours. Bronchoscopy revealed epithelialization of the reconstructions without dehiscence, stenosis, or recurrence of fistulas. The flow-volume loop was preserved in all patients and dynamic virtual bronchoscopy revealed no significant difference in the endoluminal cross surface areas of the airway between inspiration and expiration above (45 ± 21 mm²), at the site (76 ± 23 mm²) and below the reconstruction (65 ± 40 mm²).

CONCLUSIONS: Intrathoracic airway defects of up to 50% of the circumference may be repaired using extrathoracic muscle flaps when an end-to-end reconstruction is not feasible.

This article has been cited by other articles:

				E. Ridgway, M. DeCamp, and D. Morris Bronchopleural Fistula Repair Using Combined Breast Parenchymal and Pectoralis Major Musculocutaneous Flap Ann. Thorac. Surg., September 1, 2008; 86(3): 1022 - 1025. [Abstract] [Full Text] [PDF]

				A. Abolhoda, G. A. Wirth, T. D. Bui, and J. C. Milliken Harvest technique for pedicled transposition of latissimus dorsi muscle: an old trade revisited Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 928 - 930. [Abstract] [Full Text] [PDF]

				H.-B. Ris, T. Krueger, C. Cheng, P. Pasche, P. Monnier, and L. Magnusson Tracheo-carinal reconstructions using extrathoracic muscle flaps Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 276 - 283. [Abstract] [Full Text] [PDF]

				G. W. Gladish, D. C. Rice, B. S. Sabloff, M. T. Truong, E. M. Marom, and R. F. Munden Pedicle Muscle Flaps in Intrathoracic Cancer Resection: Imaging Appearance and Evolution RadioGraphics, July 1, 2007; 27(4): 975 - 987. [Abstract] [Full Text] [PDF]

				C. M. Heyer, T. G. Nuesslein, D. Jung, S. A. Peters, S. P. Lemburg, C. H. L. Rieger, and V. Nicolas Tracheobronchial Anomalies and Stenoses: Detection with Low-Dose Multidetector CT with Virtual Tracheobronchoscopy--Comparison with Flexible Tracheobronchoscopy Radiology, February 1, 2007; 242(2): 542 - 549. [Abstract] [Full Text] [PDF]

				E. Pezzetta, R. Stupp, A. Zouhair, L. Guillou, P. Taffe, C. von Briel, T. Krueger, and H.-B. Ris Comparison of neoadjuvant cisplatin-based chemotherapy versus radiochemotherapy followed by resection for stage III (N2) NSCLC Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1092 - 1098. [Abstract] [Full Text] [PDF]