Abstract
A 73-year-old man who had received total laryngectomy for laryngeal cancer injured his air way while doing tracheostomy care by a cotton swab, and he was admitted to our hospital. Chest computed tomography showed rupture of the lower part of the trachea and mediastinal emphysema, and bronchoscopic findings showed membranous tracheal rupture with a defect necessitating surgery. On the next day, surgery via right lateral thoracotomy demonstrated membranous tracheal rupture slightly craniad to the azygos vein. Direct closure of the rupture was carried out with placement of a pedicled right 5th intercostal muscle flap between the esophagus and the injured site. The postoperative course was uneventful. In the case of membranous tracheal rupture due to a blunt trauma increasing the endotracheal pressure, conservative therapy can be employed. However, this case was of an injury associated with a transmural defect, in which spontaneous closure could not be expected. Early surgical closure was thus performed. We could select thoracoscopic surgical procedure to dissect the esophagus. Considering his primary lesion to be laryngeal cancer, we performed this procedure by using a pedicled intercostal muscle flap, with favorable outcome.
