For deep mediastinal reconstruction, surgical options should be considered and selected according to the patient’s primary disease, the area of the defect, and the exposed critical organs such as trachea, aorta, and esophagus. In particular, during posterior mediastinal reconstruction cases, the bronchial stump or exposed stents used for esophagus and aorta coverage is used in order to prevent serious complications, such as bronchopleural or aortoesophageal fistula, associated with high morbidity and mortality. Reinforcement of critical structures is often achieved through the use of various flaps. For example, thoracic surgeons prefer to use the intercostal muscle, pericardial fat pad, pleura, and diaphragm. On the other hand, in some circumstances, plastic surgeons need to carefully repair complicated defects by performing local flaps or microvascular free tissue transfers. Although microsurgical reconstruction is versatile and can be used in challenging cases, appropriate selection of recipient vessels is critical for successful free tissue transfer in intra-thoracic lesions. In this report, we present our experience using the latissimus dorsi free flap via intra-thoracic microvascular anastomoses for coverage of a bronchial stump and for endovascular aortic stent-graft exposure.
