Total arch replacement via antero-lateral thoracotomy with partial sternotomy in patients with a tracheostoma: report of two cases

Miyahara, Shunsuke; Inoue, Takeshi; Minami, Hiroya; Okada, Kenji; Okita, Yutaka

doi:10.1007/s00595-013-0537-1

Surg Today

2013

DOI: 10.1007/s00595-013-0537-1

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Total arch replacement via antero-lateral thoracotomy with partial sternotomy in patients with a tracheostoma: report of two cases

Shunsuke Miyahara

Takeshi Inoue

Hiroya Minami

et al.

Abstract: Midsternotomy in patients with a coexisting tracheostomy is associated with a risk of deep sternal wound infection (DSWI) or mediastinitis. We herein present two cases of total arch replacement using a surgical technique designed to avoid the danger of DSWI. Total arch replacement via an antero-lateral thoracotomy with partial sternotomy can be one of the options for patients with a tracheostoma or after laryngectomy, and can both protect organs and avoid DSWI.

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Cited by 5 publications

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Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy

Nallani,

Miller,

Noel‐MacDonnell

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveSternal wound infection (SWI) is a rare but potentially life‐threatening complication in children following sternotomy. Risk factors include young age, extended preoperative hospitalization, and prolonged ventilatory support. Few studies have explored the impact of pre‐existing tracheostomy on SWI in pediatric patients. The purpose of this study is to measure the effect of tracheostomy and other factors on SWI in children undergoing sternotomy.Study DesignRetrospective cohort study of a 12 year period.SettingTertiary children's hospital.MethodsChildren with a tracheostomy prior to sternotomy (TPS) were identified and matched by age, height, and weight to children who underwent sternotomy alone. Demographics, medical comorbidities, surgical details, SWI diagnosis and management information, and surgical outcomes were collected.ResultsWe identified 60 unique individuals representing 80 sternotomies. The incidence of SWI was 22.5% (n = 9) in children with a tracheostomy and 2.5% (n = 1) in those without. The incidence of SWI was greater in children with a tracheostomy (90% vs 10% in those without, P = .007) and underlying pulmonary disease (90% vs 10% in those without, P = .020). Infections in the TPS group also demonstrated greater frequency of Pseudomonas aeruginosa (n = 3) and polymicrobial growth (n = 2).ConclusionThe risk of developing a SWI in children undergoing sternotomy is significantly greater in those with a tracheostomy and underlying pulmonary disease. Further study is needed to understand other contributing factors and ways to mitigate this risk.

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Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy

Nallani,

Miller,

Noel‐MacDonnell

et al. 2024

Otolaryngol.--head neck surg.

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Total arch replacement in a patient with a tracheostoma through a reverse L-shaped partial sternotomy

Kamada

Minatoya

Okabayashi

et al. 2016

Gen Thorac Cardiovasc Surg

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A conventional median sternotomy in a patient with a tracheostoma is susceptible to postoperative mediastinitis or graft infection after total arch replacement (TAR). An optimal surgical procedure has still not been established to circumvent these complications in such patients. We report a successful case of a 74-year-old man with a tracheostoma who received TAR through a reverse L-shaped partial sternotomy. This incision was simple and enabled us to secure an adequate operative field similar to that of a conventional median sternotomy. The patient was discharged without any evidence of infection or any other complications.

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Off-pump coronary artery bypass grafting in a tracheostomy patient

Kasai

Osako

Yamada

et al. 2018

Gen Thorac Cardiovasc Surg

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In patients who have undergone laryngectomy and have a tracheal stoma, a full median sternotomy substantially increases the risk of wound infection, osteomyelitis, mediastinitis, bleeding, tracheal injury, and poor wound healing. Several reports have been published on sternotomies and skin incisions in tracheostoma patients. Transverse bilateral thoracosternotomy, T-shaped partial sternotomy (manubrium-sparing sternotomy) with transverse skin flaps and anterolateral thoracotomy with partial sternotomy are described as successful approaches to the mediastinum for cardiac surgery. We present a successful case in which off-pump coronary artery bypass grafting (CABG) was performed in a tracheostoma patient using a low T-shaped partial sternotomy and the PAS-Port system. Good long-term results were achieved.

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Total arch replacement via antero-lateral thoracotomy with partial sternotomy in patients with a tracheostoma: report of two cases

Cited by 5 publications

References 12 publications

Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy

Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy

Total arch replacement in a patient with a tracheostoma through a reverse L-shaped partial sternotomy

Off-pump coronary artery bypass grafting in a tracheostomy patient

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