Anterior Mediastinal Tracheostomy as Salvage Operation

Free jejunal flap transfer containing multiple vascular pedicles for pharyngoesophageal reconstruction in conjunction with anterior mediastinal tracheostomy

“…This procedure was introduced by Waddell and Cannon () and Sisson et al () with reported mortality rates of 33%‐50% (Terz et al, ). Although only a few reports have described the postoperative course after anterior mediastinal tracheostomy since 1980 (Bagheri et al, ; Berthet et al, ; Biller, Krespi, Lawson, & Baek, ; Chan, Yu Chow, et al, ; Conti et al, ; Grillo & Mathisen, ; Kato et al, ; Kuwabara et al, ; Maipang et al, ; Neifeld, Theogaraj, & Mehrhof, ; Orringer, ; Sisson & Goldman, ) advances in operative techniques and patient care have dramatically reduced mortality rates to 5%‐19% (Chan, Yu Chow, et al, ; Conti et al, ). Innominate artery rupture is the main cause of mortality and is associated with pressure necrosis of the innominate artery caused by tension on the tracheostoma resulting from a short remnant trachea.…”

“…The redundant mesentery can be used as a mesenteric flap to separate the remnant trachea and innominate artery during anterior mediastinal tracheostomy. Furthermore, this redundant mesentery has additional advantages; it can protect other major vessels such as the innominate vein, subclavicular and carotid arteries, and the internal jugular vein, fill in dead space, and cover the intestinal anastomotic area, thereby decreasing postoperative complications, such as major vessel rupture, SSIs, and pharyngoesophageal fistula formation, which are also linked to innominate artery rupture (Berthet et al, ). Generally, SSIs occur in head and neck cancer surgery with flap reconstruction at a rate of 8.1% to 40.6% (Kamizono, Sakuraba, Nagamatsu, Miyamoto, & Hayashi, ; Karakida et al, ; Simons et al, ).…”

“…Anterior mediastinal tracheostomy was performed as previously described (Bagheri et al, ; Berthet et al, ; Orringer, ). Briefly, the manubrium, the medial 3rd or half of the clavicle, and the adjacent 1st rib on both sides were resected for proper neostoma construction.…”

“…Anterior mediastinal tracheostomy was performed as previously described (Bagheri et al, 2013;Berthet et al, 2014;Orringer, 1992).…”

“…Anterior mediastinal tracheostomy is a challenging procedure in which a tracheostomy stoma is constructed with the intrathoracic trachea to establish an airway (Maipang, Singha, Panjapiyakul, & Totemchokchyakarn, 1996), and is associated with high mortality rates ranging from 5% to 19% (Chan, Yu Chow, Lun Liu, & Ignace, 2011;Conti et al, 2010). This procedure is performed to treat extensive cervicothoracic malignancies and recurrence of laryngeal cancer at the stoma site (Berthet et al, 2014;Conti et al, 2010;Grillo, 1966;Maipang et al, 1996;Orringer, 1992;Sisson, Straehley Jr., & Johnson, 1962). Moreover, patients with extensive involvement of the proximal esophagus also require pharyngoesophagectomy and reconstruction.…”