Neifeld J P, Theogaraj S D, Mehrhof A I
Am J Surg. 1984 Oct;148(4):505-8. doi: 10.1016/0002-9610(84)90377-5.
Mediastinal tracheostomy has been associated with high morbidity and mortality, often due to skin necrosis, with resultant exposure of the great vessels and subsequent hemorrhage. During a 4 year period, 11 patients underwent mediastinal tracheostomy. Reconstruction included the use of a pectoralis major musculocutaneous flap to provide well-vascularized skin for anastomosis to the superior portion of the tracheostoma in nine patients. Whenever possible (eight patients), the trachea was transposed below the innominate artery to allow for slightly more mobility of the trachea and to remove the cartilaginous portion of the trachea from the artery. Among the eight elective operations reported herein, there were no postoperative deaths and only two minor wound-related complications. Among three patients who underwent emergency mediastinal tracheostomy, two patients died, one with an aneurysm of the innominate artery that ruptured several weeks postoperatively and the other with respiratory instability who could not be weaned from the respirator. These results suggest that use of the pectoralis major musculocutaneous flap and tracheal transposition decreases the risk of skin necrosis and resultant major vessel rupture. We advocate this approach in the reconstruction of the patient who requires mediastinal tracheostomy.
纵隔气管造口术常伴有较高的发病率和死亡率，这通常是由于皮肤坏死，导致大血管暴露并随后出血。在4年期间，11例患者接受了纵隔气管造口术。重建方法包括对9例患者使用胸大肌肌皮瓣，为气管造口上部提供血运丰富的皮肤以进行吻合。只要有可能（8例患者），将气管移位至无名动脉下方，以使气管有稍多的活动度，并将气管的软骨部分与动脉分离。在本文报道的8例择期手术中，无术后死亡病例，仅有2例与伤口相关的轻微并发症。在3例接受急诊纵隔气管造口术的患者中，2例死亡，1例无名动脉动脉瘤术后数周破裂，另1例呼吸不稳定，无法撤机。这些结果表明，使用胸大肌肌皮瓣和气管移位可降低皮肤坏死及由此导致的大血管破裂的风险。对于需要纵隔气管造口术的患者重建，我们提倡采用这种方法。
