Thorac Cardiovasc Surg 2012; 60 - P109
DOI: 10.1055/s-0031-1297900

Successful relocation of an infected tracheostomy at the level of the inferior manubrium sterni: No mission impossible

M Hartert 1, Ö Senbaklavaci 1, R Schuon 2, H Taspinar 1, S Ergün 1, W Mann 2, CF Vahl 1
  • 1Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Mainz, Germany
  • 2Hals-, Nasen-, Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany

Introduction: Infected tracheostomies – especially in patients after neck-oncological surgery with subsequent radiochemotherapy – are frequently associated with high morbidity and mortality rates. An oesophagotracheal fistula triggered our successful relocation of a massively infected tracheostomy down to the level of the inferior manubrium sterni.

Aims: A 59-year-old male (history of hypopharynx carcinoma in 2007 with successive laryngectomy, adjuvant radiochemotherapy and uneventful oncological follow-up) was presented to our institution after being considered inoperable in various hospitals. The following oesophageal stenosis was treated by a metal-mesh-coated stent implantation, later inducing an oesophagotracheal fistula with massive inflammation and periodical bleedings (non-controllable by regular stent alterations). The patient underwent caudal tracheostomy relocation and wound covering by pectoralis muscle flap after upper partial sternotomy. The resection of thymus plus surrounding fat tissue was followed by a dissection of the aortic arch, the supraaortal vessels and the trachea. After detachment from the infected stoma and oesophageal stent, the trachea was mobilised and relocated ventrally below the brachiocephalic trunk (lateral to the ascending aorta). Following partial resection of the manubrium sterni on both sides, a new tracheostoma was created at the level of carina. Finally, the infected area was closed by pectoralis muscle flap. After uneventful operation, the patient left the ICU within two days being discharged to rehabilitation in good condition.

Discussion: Forming a major problem in thoracic surgery, our case demonstrates an ultimate treatment method for infected tracheotomies after oesophageal fistulae in connection with neck-oncological surgery. We highly advocate this interdisciplinary venture, as it significantly improves quality of life.