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.
thoracic surgery - complication - muscle flap - tracheal injury - mediastinal infection
- mediastinoscopy
