LIFESAVING MUSCLE FLAPS IN TRACHEOBRONCHIAL DEHISCENCE FOLLOWING RESECTION OR TRAUMA

Objective: In the presence of acute inflammation and necrosis of the w all, tracheo-bronchial defects are difficult to manage. The absence of adequate vascularization and the contaminated area prevent successful direct re-suturing. Methods: In order to restore a sufficient blood s upply we used a pedicled latissimus dorsi or a pectoralis major flap t hat was entered into the thorax after a 10-cm resection of the second rib. A portion of the muscle was fitted into the tracheo/bronchial def ect by reinforced sutures. The remaining muscle was sutured to the tis sue surrounding the defect. This method was applied in various septic conditions: Bronchial defects; complete dehiscence of the right (n = 6 ) or left (n = 1) main bronchus at the carinal level following resecti on for lung cancer (n = 4) or for tuberculous (n = 2) or nontuberculou s pleuropneumonia (n = 1). Tracheal defects; (1) destruction of one th ird of the tracheal circumference involving the cricoid down to the fo urth ring following tracheotomy in presence of a septic sternum after intrathoracic goiter and Bechterew's disease; (2) 30% dehiscence of th e anastomosis and septic sternum following tracheal resection; (3) Med iastinitis involving tracheal and esophageal wall following a 7 cm lon g iatrogenous laceration of the intrathoracic trachea. Results: In one case the latissimus dorsi developed venous stasis on day 2 and was re placed by the pectoralis major muscle which showed uneventful healing. In all other patients the muscle flap resulted in an uneventful closu re of the defect and recovery. Conclusions: Large, well vascularized, pedicled muscle flaps ensure a safe closure of tracheo-bronchial defec ts or dehiscences even in presence of gross necrosis and sepsis. (C) 1 997 Elsevier Science B.V.