Tipped lung tissue flap in tracheal reconstruction

  In tracheal surgery, most tracheal lesions can be resected and safely completed with stage I reconstruction, but for some patients, the conflict between the safety of surgical resection and the radical nature of the tumor is often unavoidable, limited by the length of the trachea that can be safely resected. Most of the patients in this part are then lost to surgery, and in some cases, although surgical resection is done, they do not have a high quality of life after surgery and even suffer from serious complications for a long time.  Up to now, tracheal surgery has made some achievements in non-autologous material transplantation, but there is no breakthrough, which is the bottleneck of the current development of tracheal surgery. Yesterday, two cases of tracheal reconstruction with tipped lung tissue flap plus nickel-titanium alloy mesh tracheal stent were reported in the National Symposium on Tracheal Surgery, and according to the follow-up of the reporters, the results were good and worthy of reference, which are briefly described as follows.  In both cases, the lesions were located in the right wall of the trachea in the thoracic segment. First, the lateral wall of the trachea was incised at the inferior margin of the tumor, the transoral tracheal tube was removed, and pulmonary ventilation was established on the rapid stage. In the second step, the tracheal tumor and the tracheal wall affected by the tumor were removed and the bronchial stump was sent for rapid cryopathological examination until the stump was negative. In the third step, a nickel-titanium alloy mesh tracheal stent of appropriate diameter is implanted, usually about 1 mm larger than the trachea in diameter and about 5 mm longer than each side of the defect.  In the fourth step, construct a tipped lung tissue flap: free the bronchus of the anterior segment of the upper right lung lobe, cut and ligate it, and use a cutting closure to cut between the anterior and posterior apical segments of the upper right lung lobe, paying attention to protecting the blood supply to the lung segment, and shape the free anterior segment of the upper right lung lobe into a tongue-shaped flap. In the fifth step, the lung segment of the lingual flap is fixed with continuous sutures on the edge of the defective trachea and then fixed with the nearest mediastinal pleural covering. In the sixth step, the lungs were aspirated and puffed without air leakage, and the chest was closed.  Postoperatively, both patients were successfully discharged within 2 weeks without anastomotic fistula. Long-term bronchoscopic follow-up of the patients was performed after discharge, and bronchoscopy was repeated in the second year after surgery to see that the metal mesh frame was no longer evident, and the lumen was usually smooth with a smooth inner wall.  In fact, reconstruction of trachea and bronchi with autologous tissue plus non-autologous materials has been reported for a long time, but it is the first case in which lung tissue was chosen from autologous tissue.  The advantages of choosing lung tissue from autologous tissue are: i. The proximity to trachea and bronchus allows for the extraction of materials in close proximity. ii.  Second, autologous lung tissue is rich in blood flow and has no rejection reaction, so it is easy to be viable.  Third, the lung tissue is soft, with smooth surface and low tension, so it is not easy to form a scar.