Treatment of late tracheomediastinal fistula following diagnostic mediastinoscopy treated by multiple pedicled muscle flaps

During mediastinoscopy in a 38-year-old woman, there was uncontrolled bleeding that required a sternal split. One month later, chest and neck CT scan demonstrated tracheomediastinal fistula. The patient underwent urgent operation. Repair of the tracheal defect was accomplished using a pedicled right sternohyoid muscle; the right sternocleidomastoid muscle was used to separate the trachea from the innominate artery and the left pectoralis major muscle was used to fill the anterior mediastinal space. The postoperative course was uneventful. One month later, another CT scan demonstrated complete resolution. Careful use of coagulation during mediastinoscopy is of paramount importance to avoid thermal injury to the trachea. This case also underlines the importance of a good knowledge of the anatomy of the skeletal muscles of the chest wall and adjacent regions. © Georg Thieme Verlag KG Stuttgart • New York.