A new technique for substernal colon transposition with a breast dissector: Report of 39 cases
Section snippets
Materials and methods
Between 1998 and 2004, 39 patients underwent oesophageal reconstruction due to caustic ingestion. There were 27 women and 12 men, aged from 7 to 70 years. The oesophagectomy and the reconstruction were performed at our Department of Plastic Surgery. The patients have been directly referred to the senior author (Hung-Chi Chen) who performed the reconstructive procedures.11, 12, 13 The thoracic oesophagectomy was performed endoscopically by the thoracic surgeons.
A pedicled colon segment was
Results
All 68 colon segments were successfully transferred in all patients. In all the 39 cases where the breast dissector was used no pneumothorax was observed. In 34% of patients belonging to the control group (hand dissection) pneumothorax occurred which was treated successfully with a chest drain.
The operative time of the substernal route was 10±2 min with the breast dissector, and 25±3 with the conventional manual method. In those cases where a chest tube was necessary, the overall operative time
Discussion
The substernal route is a well-known procedure, even though some reports have focused on the pneumothorax complication during oesophageal reconstruction.7, 15, 16
Although other ancillary devices (e.g. a flexible board) have been reported for the dissection of the substernal tunnel,7 we introduced in chest surgery the use of a breast dissector largely known among plastic surgeons.
The breast dissector is firm, flat, with a dull edge; moreover, it is safe for blunt dissection of the substernal
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