Treatment of Synchronous Traumatic Perforations of the Trachea and the Esophagus With Two Inferiorly Based Strap Muscle Interposition Flaps: An Innovative Approach.

ABSTRACT

Traumatic perforations of the esophagus and trachea are devastating injuries that necessitate prompt treatment. Large defects benefit from coverage with well vascularized tissue. Injuries at the level of the thoracic inlet are more challenging, as the options for local tissue coverage are limited.This report describes the case of a 24-year-old male who suffered gunshot wounds to his neck resulting in right posterolateral tracheal perforation as well as esophageal perforation at the level of the thoracic inlet. Bronchoscopy and esophagogastroduodenoscopy showed injury of the trachea at 19 cm from the incisors and 2 large defects of the anterior and posterior esophagus at 26 cm. The esophageal defects were temporized with a stent at a first stage. Plastic surgery team was then consulted for flap coverage of the defects.The thoracic team exposed the tracheal and esophageal perforations with a j-type incision of the neck, extending to the sternal notch, and the esophageal stent was removed. The 2 muscles, sternohyoid (SH) and sternothyroid (ST), were dissected free and were inferiorly rotated after they were disinserted superiorly. The SH was placed between the trachea and the esophagus, and the ST between the esophagus and the spine.Postoperative, the patient was receiving nutrition via a gastrostomy tube. An esophagogram was performed on postoperative day (POD) # 7, which showed no esophageal leak. Postoperative diet was started and the patient was discharged on POD# 10 in a good condition. Twelve months postoperative, his wounds were found to be intact, and had no trouble either with breathing or swallowing. LEVEL OF EVIDENCE V.