Gomes M N, Kroll S, Spear S L
Ann Thorac Surg. 1987 May;43(5):539-43. doi: 10.1016/s0003-4975(10)60205-6.
Upper airway obstruction in primary or recurrent carcinomas of the head and neck extending into the mediastinum may demand surgical intervention despite severe technical difficulties in patients with tumors previously considered inoperable. In fact, many of these tumors may be operable and some perhaps curable. A technique has been developed based in part on our experience with previously described procedures. A preliminary sternal split is used to demonstrate the extent of the mediastinal involvement as well as to provide enhanced exposure and proximal control of the great vessels. The pectoralis major muscle is used with a generous flap of overlying skin comprising nearly half of the anterior portion of the chest. A tracheostomy is then created in a fashion similar to the placement of a cardiac valvular prosthesis by creating a circular defect in the pectoralis major flap and suturing it to the tracheal remnant. This technique offers a reasonably safe and reliable means of creating a low anterior mediastinal tracheostomy for tumors previously considered inoperable. The preliminary sternal split makes the procedure safer and easier to perform, and the use of a very large pectoralis major island flap allows for reliable closure of the resulting mediastinal and sternal defects.
原发或复发性头颈部癌累及纵隔导致上气道梗阻时，尽管对于先前认为无法手术的肿瘤患者存在严重的技术难题，仍可能需要进行手术干预。事实上，这些肿瘤中的许多可能是可手术切除的，有些甚至可能治愈。我们在部分先前描述的手术经验基础上开发了一种技术。初步的胸骨劈开用于显示纵隔受累程度，并提供更好的暴露以及对大血管的近端控制。使用胸大肌及其上方一大块包含胸部前部近一半的皮瓣。然后，以类似于心脏瓣膜假体置入的方式进行气管造口术，即在胸大肌皮瓣上制造一个圆形缺损并将其缝合到气管残端。该技术为先前认为无法手术的肿瘤创建低位前纵隔气管造口术提供了一种合理安全且可靠的方法。初步的胸骨劈开使手术更安全且更易于操作，使用非常大的胸大肌岛状皮瓣可可靠地闭合由此产生的纵隔和胸骨缺损。
