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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Douglas J. Mathisen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mathisen, D. J. Search for Related Content PubMed Articles by Mathisen, D. J. Related Collections Trachea and bronchi Related Article

Ann Thorac Surg 2001;71:413
© 2001 The Society of Thoracic Surgeons

Invited commentary

^a General Thoracic Surgical Unit, Massachusetts General Hospital, Boston, MA 02114, USA

e-mail: dmathisen{at}partners.org

Kuwabara and associates are to be congratulated on their outstanding results achieved in seven patients requiring mediastinal tracheostomy. The authors describe two technical modifications that are valuable contributions. They correctly identify the serious complications of this demanding surgical procedure—massive hemorrhage from the innominate artery. This usually occurs because of either erosion of the trachea into the innominate artery or exposure of this vessel from wound separation. They have reduced this risk by transposing the trachea beneath the innominate artery and between the superior vena cava and aorta and using the omentum to cover, buttress, and separate the great vessels. Elective division of the innominate artery under electroencephalographic monitoring has been used to eliminate the risk of tracheal erosion and may be preferable in large patients or in cases in which less than 5 cm of trachea is available [1]. The use of the omentum either with the stomach or separately when colon bypass is the conduit of choice avoids the need for complicated muscle flaps and more easily accommodates the reconstructive demands of this procedure. The omentum can be utilized by thoracic surgeons as an adjunct to manage many complicated cardiothoracic problems [2]. The authors also recognize the need to create a tube of the stomach to reduce the bulk of the stomach and omentum to allow easy passage into the neck.

Mediastinal tracheostomy is a valuable procedure that may be lifesaving in some patients and offers tremendous palliation for others. Because of the complexity of the operation, its justfication is warranted only when it can be performed safely. With a successful outcome, the functional result is the equivalent of a laryngectomy.

The authors correctly identified the major pitfall of the procedure and offered useful technical alternatives that will be helpful to those who perform this demanding procedure.

References

1. Grillo H.C., Mathisen D.J. Cervical exenteration. Ann Thorac Surg 1990;49:401-409.[Abstract]
2. Mathisen D.J., Grillo H.C., Vlahakes G.J., Daggett W.M. The omentum in the management of complicated cardiothoracic problems. J Thorac Surg 1988;95:677-684.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Douglas J. Mathisen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mathisen, D. J. Search for Related Content PubMed Articles by Mathisen, D. J. Related Collections Trachea and bronchi Related Article