Advantages of a latissimus dorsi muscle flap to close a gastric tube-to-tracheal fistula and prevent tracheobronchial complications after salvage surgery for esophageal cancer: report of three cases

Abstract

Tracheobronchial fistulae after esophagectomy are rare but critical complications because they frequently cause severe pneumonia. In three cases with esophageal cancer, we used the latissimus dorsi muscle after esophagectomy to reinforce the fragile tracheobronchus. In cases 1 and 2 with gastric tube-to-tracheal fistula, the gastric tube was pulled out from the posterior mediastinum, the fistula was excised, and the trachea was covered with the pedicle latissimus dorsi muscle flap followed by reconstruction of the digestive conduit by the subcutaneous route. Case 3 had relapsed esophageal cancer after definitive chemoradiotherapy for T4 (trachea) esophageal cancer; we performed salvage surgery and covered the fragile tracheobronchus using the muscle. Various muscles have been used as reinforcement for the tracheobronchus. The latissimus dorsi muscle is especially useful to reinforce tissue with extensive lesions from the upper trachea to the bilateral bronchi because of this large and highly vascularised tissue.