Postoperative tracheoesophageal or bronchoesophageal fistulas represent a major surgical challenge. The authors report the description of an original perforator-based intercostal artery muscle flap, aiming to cover all types of intrathoracic fistulas, from any location, in difficult cases such as postoperative fistulas after esophagectomy in an irradiated field. Between June of 2016 and January of 2019, eight male patients were treated with a perforator-based intercostal artery muscle flap. All had previous surgery for esophageal cancer and developed a tracheoesophageal or bronchoesophageal fistula during the perioperative course. The mean patient age was 55.9 ± 8.8 years. All patients received neoadjuvant chemotherapy and seven received neoadjuvant radiation therapy. A perforator-based intercostal artery muscle flap, with a mean skin paddle size of 9.86 × 5 cm, was harvested. The median operative time was 426.50 minutes. The tracheoesophageal or bronchoesophageal fistula was successfully and definitively occluded in three patients; two patients experienced recurrence; and one patient underwent re operation. At 1 year, five patients were alive (62.5 percent), and among them, three (37.5 percent) were free from any intrathoracic complications. Three patients died, because of massive digestive bleeding, mesenteric ischemia, and multiorgan failure, respectively. The perforator-based intercostal artery muscle flap, like the Taylor flap in abdominoperineal reconstruction, could become a workhorse flap for all intrathoracic reconstructions, as it can always be harvested, even if a previous thoracotomy has ruined most of the options. This surgical technique, easily feasible, reliable, and reproducible, became our first option for all postoperative tracheoesophageal or bronchoesophageal fistula patients during the postoperative course following esophagectomy.

Resumo Como se produzem e consolidam os fluxos de circulação internacional na América Latina? Como tem mostrado uma ampla literatura, a circulação internacional de pessoas não se produz automaticamente, mas é produto de dinâmicas sociais complexas. Esse trabalho reconstrói os processos pelos quais pode se produzir um fluxo de estudantes argentinos em direção ao Programa de Pós-Graduação em Antropologia Social do Museu Nacional (PPGAS-MN). A partir de um trabalho de arquivo no PPGAS-MN e de entrevistas com professores e ex-estudantes, o estudo revela os mecanismos institucionais construídos por pesquisadores dos dois países para possibilitar esse fluxo que, posteriormente, teve continuidade, argumentando que esses se tornaram possíveis pela assimetria entre o estado de autonomização e financiamento da disciplina num e noutro país e, ao mesmo tempo, pela homologia de posições em que se encontravam os pesquisadores brasileiros e argentinos, os primeiros pelo avanço que já tinha a pós-graduação e os segundos pela existência de uma graduação específica em Antropologia, inexistente no Brasil.