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Ann Thorac Surg 2007;84:1777-1779. doi:10.1016/j.athoracsur.2007.08.002
© 2007 The Society of Thoracic Surgeons
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Abel Gómez-Caro
Josep Maria Gimferrer
Paolo Macchiarini
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Right arrow Trachea and bronchi

How To Do It

Technique to Avoid Innominate Artery Ligation and Perform an Anterior Mediastinal Tracheostomy for Residual Trachea of Less Than 5 cm

Abel Gómez-Caro, MD, Josep Maria Gimferrer, MD, Paolo Macchiarini, MD, PhD*

Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain

Accepted for publication August 1, 2007.

* Address correspondence to Dr Macchiarini, Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, 170 Villaroel, Barcelona E-30889, Spain (Email: pmacchiarini{at}ub.edu).

A 47-year-old man was admitted with recurrent autolimited bleeding arising from a cervical tracheostoma made 2 years earlier during a total laryngectomy. Stomal recurrence of the past laryngeal cancer invading the neighboring innominate artery was diagnosed by angiographic computer tomography and bronchoscopic biopsies. The malignant tracheostoma-innominate fistula was approached through an extended transversal supraclavicular incision, bilateral hemiclaviculectomy, and manubriectomy. It was treated with an anterior mediastinal tracheostomy with omental major transposition, right latissimus dorsi myocutaneous flap for tissue coverage, and brachiocephalic artery rerouting with cadaveric homograft. The patient was discharged on postoperative day 14 after an uneventful postoperative course.




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