gms | German Medical Science

127. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

20.04. - 23.04.2010, Berlin

Tracheal reconstruction with Pectoralis Major Myocutaneous Flap

Meeting Abstract

  • Ali Abbasi - Royal Brompton Hospital, Thoracic Surgery Service, London, Great Britain
  • Eric Rößner - Royal Brompton Hospital, Thoracic Surgery Service, London, Great Britain
  • Andrew Nicholson - Royal Brompton Hospital, Histopathology, London, Great Britain
  • Titus Adams - Royal Marsden Hospital, London, Great Britain
  • Paul Harris - Royal Marsden Hospital, London, Great Britain
  • Peter Rhys-Evans - Royal Marsden Hospital, London, Great Britain
  • Simon Jordan - Royal Brompton Hospital, Thoracic Surgery Service, London, Great Britain

Deutsche Gesellschaft für Chirurgie. 127. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 20.-23.04.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10dgch737

DOI: 10.3205/10dgch737, URN: urn:nbn:de:0183-10dgch7371

Veröffentlicht: 17. Mai 2010

© 2010 Abbasi et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: The management of tumours invading the trachea represents a surgical challenge, especially those requiring tracheal reconstruction. The use of myocutaneous flaps has the advantage of allowing wider resection of the tumour with single-stage reconstruction of the tracheal defect.

Materials and methods: We present the case of a 65-year old male with MEN 2A syndrome with previous radical thyroidectomy and radiotherapy for thyroid medullary carcinoma. He re-presented with left vocal cord palsy, dyspnoea and new onset stridor and haemoptysis. At bronchoscopy, he was found to have recurrence of thyroid carcinoma invading through the left tracheal wall with 80% obliteration of the lumen.

Initially, rigid bronchoscopy and diathermy disobliteration was performed. The patient subsequently underwent tracheal resection through a cervical approach with a partial sternotomy. The resection involved half of the circumference of the tracheal over a 7cm length.

The tracheal defect was patched with a de-epithelialised pectoralis major myocutaneous flap. Two batons of costal cartilage were inserted longitudinally beneath the dermis of the flap in order to prevent the flap reconstruction from prolapsing into the tracheal lumen.

Results: At bronchoscopy one week post-procedure, hairs were seen to be growing from the myocutaneous flap and mucous was adherent to the area. After a further 6 weeks, there was no residual mucous in this area and the hairs had now disappeared, with biopsies at 9 months post-op showing mainly non-keratinising squamous epithelium but also focal areas comprising ciliated respiratory epithelium thereby allowing muco-ciliary clearance.

Conclusion: Tracheal reconstruction using reinforced pectoralis major myocutaneous flap allows extensive resection of trachea whilst ensuring airway patency. Deepithelialisation of the flap provides opportunity for growth of surrounding respiratory epithelium over the graft thereby re-establishing muco-ciliary clearance.