Reconstruction of a Long-Segment Tracheal Defect using an Alloderm Conduit

Abstract

This case describes successful reconstruction of a long-segment tracheal defect using AlloDerm as the conduit for reconstruction. A 38-year-old woman who had undergone a thyroid lobectomy in 2011 presented several months later unable to swallow. Chest computed tomography results revealed a tracheal/esophageal mass and a subsequent bronchoscopy, and esophagogastroduodenoscopy results revealed an upper esophageal/tracheal mass with two areas concerning for fistula. She underwent a bronchoscopy with a tracheal stent and percutaneous endoscopic gastrostomy placement. All biopsies were nondiagnostic for malignancy and the patient recovered well. After a repeat bronchoscopy and esophagogastroduodenoscopy a few months later, she underwent a diagnostic right video-assisted thoracoscopic surgery and thoracotomy. To obtain adequate tissue for diagnosis, the fistula was opened, resulting in a large defect in the esophagus and trachea, as portions of the trachea, esophagus, and right recurrent laryngeal nerve liquefied. A 7-cm portion of her esophagus, 8 cm of the posterior trachea, and 5 cm of the right trachea wall were removed. The pathology came back as Hodgkin lymphoma. Because of the size of the esophageal defect, reconstruction was not an option. Therefore, the remainder of the esophagus was resected, the stomach stapled off, and esophageal hiatus closed. The tracheal defect was also too large for patch repair and was reconstructed with a tube of AlloDerm (6 × 10 cm). Four years after reconstruction, the patient is disease free and living a normal life. This case demonstrates successful tracheal reconstruction with AlloDerm.