Closing a tracheal defect with an omental pedicled gastric flap; a technical note

Due to an adenocarcinoma of the right upper lobe with infiltration of the main bronchus a 49-years-old female patient underwent an upper bilobectomy with sleeve resection. After two completed chemotherapy bouts and signs of sepsis another thoracotomy was inevitable. As a complicating factor a supracarinal, necrotic and perforating lesion of the trachea appeared. The defect can be initially repaired with a suture and covered with azygos vein material. However surgical revision showed an enlargement of the tracheal necrosis. Then the lesion was occluded with a diaphragmatic pedicled flap. Nevertheless after the operation a tracheal insufficiency with massive ventilation leakage was observed. It was generated by the death of the diaphragmatic flap. As an ultimate therapeutic measure a transplantation of a pedicled omental gastric flap was performed, which in case of a failure of the conventional operative techniques, is an additional option in closing tracheal defects caused by infections. Especially in cases of massive infected thoracic cavity and tracheal necrosis omentum majus is, compared to muscle flaps, the better biological tissue to close and heal the tracheal defect. This case report firstly describes a successfully closure of a tracheal defect using the technique mentioned above

Severe thoracic trauma due to an intrathoracic dislocation of a fractured humeral head in an aged patient; a case report

Fracture and intrathoracic dislocation of the humeral head are extremely rare and often the result of a severe trauma. We herein report a case of humeral head fracture and dislocation with displacement into the chest cavity. A 75-year-old man fell down the stairs at home, landing on the right half of his body. Clinical impressive was a massive skin emphysema on the right hemithorax. A chest x-ray was performed. Conspicuous was a dubious opacity in the right subfield of the lung. The following CT-scan showed an additional fracture of the right scapula, a lung contusion and as "corpus delicti" a right intrathoracic dislocated humeral head fracture. The current case is extremely rare pattern of injury and the surgical emergency management is discussed. In most patients, a thoracotomy, which is related to a higher lethality and higher morbidity, can be avoided, if after stabilization a video assisted thoracoscopy is performed for revision of the pleural cavity and extraction of the humeral head