Successful reconstruction of an intrathoracic tracheal defect using a muscle flap and conchal cartilage graft
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HOW I DO IT
Successful reconstruction of an intrathoracic tracheal defect using a muscle flap and conchal cartilage graft Kosuke Maitani1 · Makoto Yamasaki2 · Naoya Otani1 · Shien Seike1 · Koichi Tomita1 · Kotaro Yamashita2 · Koji Tanaka2 · Tomoki Makino2 · Yuichiro Doki2 · Tateki Kubo1 Received: 2 July 2020 / Accepted: 14 August 2020 © The Japan Esophageal Society 2020
Abstract Background Malignant invasion of the respiratory tract is a common complication in advanced cases of esophageal carcinoma. Resection and reconstruction can be extremely challenging, particularly when the invasion is intrathoracic. A circumferential tracheal resection with direct tracheal closure or mediastinal tracheostomy is often performed, but the outcome is not always favorable, with high morbidity rates, loss of vocal function, and reduced quality of life. Methods We present our experience in performing an intrathoracic tracheal reconstruction in which a conchal cartilage graft was used in combination with a pectoralis major muscle transposition. Results This was successfully done following the noncircumferential resection of the intrathoracic trachea due to mural invasion by a metastatic lymph node of esophageal carcinoma. Conclusions We believe this report will contribute to the growing body of clinical expertise on procedures for intrathoracic tracheal reconstruction. Keywords Esophageal carcinoma · Tracheal invasion · Intrathoracic tracheal reconstruction · Pectoralis major muscle flap · Conchal cartilage graft
Introduction The mediastinum is a complicated structure tightly packed with crucial organs, such as the esophagus, trachea, and great vessels. Tracheal invasion is often observed during the clinical course of esophageal carcinoma and is generally a sign of poor prognosis and imminent reduction in a patient’s quality of life [1]. Progress in multidisciplinary approaches, such as chemotherapy and chemoradiotherapy, has led to more favorable prognoses, and only a limited number of patients with esophageal cancer who are elderly or those with comorbidities are not indicated for surgery because radical surgery is highly invasive. A previous study found * Tateki Kubo [email protected]‑u.ac.jp 1
Department of Plastic Surgery, Osaka University Graduate School of Medicine, 2‑2‑C11 Yamadaoka, Suita‑shi, Osaka 565‑0871, Japan
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2‑2 Yamadaoka, Suita‑shi, Osaka 565‑0871, Japan
2
that tracheal lesion resection could be adapted as part of the multidisciplinary treatment for patients without distal metastasis; accordingly, this approach should be considered for all such patients whenever possible [1–3]. Notably, tracheal reconstruction is technically demanding, especially when performed intrathoracically. After chemoradiation therapy for esophageal cancer, the difficulty is heightened even further. Here, we document a case of successful tracheal resection and reconstruction using a conchal cartilage graft for pectoralis major muscl
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