Anatomic basis of tracheobronchial reconstruction by intercostal flap.

A feasibility study was carried out to standardise the use of the intercostal muscle flap (ICF) for reconstruction of the posterior wall of the trachea and bronchi. The program consisted of two stages. Morphologically, in anatomic specimens, intercostal muscle flaps were dissected that could be used whatever the morphotype of the subject. Ten human cadavers were dissected after a right thoracotomy in the 6th right intercostal space, providing flaps 12 to 18 cm long and 1.5 to 3 cm wide. Experimentally, studies were made on 7 dogs of the functional and anatomopathologic aspects of the reconstruction at the 20th postoperative day. The results showed impermeability and rapid healing at endoscopy on the 10th postoperative day in every case as well as regeneration of ciliated epithelium in 6 of the 7 cases. The ICF may therefore be considered for losses of tracheobronchial substance, whether accidental, spontaneous (fistulae) or deliberate (surgery for malignant or benign lesions).