Use of the extended pectoralis major myocutaneous flap as a wrap-around for mediastinal tracheal repair

• Main Authors: Grace Hui-Min Tan, (MRCS), Boon-Hean Ong, (FRCSEdTh), Yee-Onn Kok, (MRCS), Bien-Keem Tan, (FRCS)
• Format: Article
• Language: English
• Published: Elsevier 2021-12-01
• Series: JPRAS Open
• Subjects: Tracheo-esophageal fistula; mediastinal tracheal defect; flap repair; pectoralis major myocutaneous flap
• Online Access: http://www.sciencedirect.com/science/article/pii/S235258782100070X

Summary: Persistent tracheoesophageal fistulas requiring flap repair of the trachea in the mediastinum are uncommon. A 44-year-old man developed a 5 cm x 2 cm persistent posterior tracheal defect after failed tracheo-esophageal fistula repair. The defect was patch repaired using the de-epithelialized skin paddle of an extended pectoralis major flap tunneled into the mediastinum. The use of cross-field ventilation, second rib removal and an anterior tracheostomy slit were crucial for posterior tracheal repair. No major complication occurred. The patch repair with the de-epithelialized skin paddle of pectoralis major flap mucosalized in 2 weeks and the patient was discharged one month postoperatively. The extended skin paddle of the pectoralis major flap was a useful method for tracheal wrap-around reconstruction.