# Reconstruction of a Complex Posterior Tracheal Wall Defect via Transtracheal Running Suture and Pedicled Pectoralis Major Muscle Flap

## TL;DR

This paper describes a successful surgical technique for repairing a large tracheal wall defect after esophageal resection using a muscle flap and a T-shaped incision.

## Contribution

The novel approach combines a transtracheal running suture with a pedicled pectoralis major muscle flap for posterior tracheal wall reconstruction.

## Key findings

- A long tracheal membranous wall defect (>7cm) was successfully repaired using the described technique.
- The method avoided the need for cardiopulmonary bypass and resulted in a favorable outcome.
- The T-shaped incision and muscle flap provided effective anastomotic buttressing.

## Abstract

A tracheal membranous injury is a known complication of tracheostomy. After esophageal resection, such injury may prove fatal. No natural buttressing of the lesion occurs, and severe sepsis and mediastinitis may occur. In these situations, a circumferential tracheal resection is the treatment of choice, sometimes on cardiopulmonary bypass. However, the outcome is not always favorable.

We report a case of a long tracheal membranous wall defect (> 7cm) after esophageal resection. We successfully performed a transtracheal direct repair of the defect through a partial sternotomy, and reconstructed the ventrolateral wall with a muscle flap using the right pectoralis major muscle.

Tracheal reconstruction through a T-shaped incision and anastomotic buttressing using a pectoralis major muscle flap could prove to be useful when reconstructing a posterior tracheal wall injury, especially after esophageal resection.