Fleischer A, Khafif R
Department of Surgery, Maimonides Medical Center, Brooklyn, N.Y.
Plast Reconstr Surg. 1989 Aug;84(2):342-6. doi: 10.1097/00006534-198908000-00025.
A young patient with a massive postirradiation recurrence of thyroid cancer invading the larynx and mediastinal trachea had been treated by resecting the larynx and trachea to within three rings of the carina. A mediastinal tracheostomy was avoided by using a tubed pectoralis major myocutaneous flap to replace the ablated trachea. The flap, transferred into the mediastinum subclavicularly, was connected to the tracheal stump and exteriorized as a cervical tracheostomy. This resulted in direct closure of the donor site and primary healing. Four years after the operation, the patient remains free of disease and is tolerating the neotrachea without difficulty or complications. The technique described is offered as an alternative to conventional mediastinal tracheostomy methods, which have acknowledged shortcomings.
一名年轻的甲状腺癌患者在放疗后出现大量复发，肿瘤侵犯喉部和纵隔气管，通过将喉部和气管切除至隆突下三个气管环进行治疗。通过使用带蒂胸大肌肌皮瓣替代切除的气管，避免了纵隔气管造口术。该皮瓣经锁骨下转移至纵隔，与气管残端相连，并作为颈部气管造口术引出体外。这使得供区能够直接闭合并实现一期愈合。术后四年，患者无疾病复发，能够顺利耐受新气管，未出现困难或并发症。所描述的技术可作为传统纵隔气管造口术方法的替代方案，传统方法存在公认的缺点。
