Title: Tracheal Reconstruction Using Pericardium in Emergency as a Life Saving Procedure in Cases of Severe Tracheal Stenosis
Authors: Dr Dheeraj Sharma, Dr Anula Sisodia, Dr Sanjeev Devgarha, Dr Rajendra Mohan Mathur
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.35
Background: Post intubation tracheal stenosis followed by tracheostomy resulting in destruction of long segment of trachea remains a serious clinical problem. In this study we review our experience with technique of tracheal reconstruction using pericardial flap/patch as an emergency procedure to save life of patient. Method: Since Dec 2011 to Dec 2012, a total of 5 patients with tracheal stenosis as a result of intubation and tracheostomy were included in this study and examined for outcomes of stenosis management. Results: Our treatment strategy for treatment of long segment of tracheal stenosis with pericardial patch/flap was associated with good outcomes. The overall success rate was 80% with no early and late complications. Conclusion: Long term endotracheal intubation and tracheostomy results in destruction of long tracheal segment causing end to end and other repaires impossible. Therefore our technique for long segment tracheal stenosis using pericardium remains a good alternative in an emergency as a life saving procedure. Keywords: Tracheal reconstruction, tracheal stenosis, tracheostomy, pericardial flap 1. Grillo HC, Donahue DM, Mathisen DJ, Wain JC: Postintubation tracheal stenosis. Treatment and result. J Thorac Cardiovasc Surg 1995, 109:486-492. 2. Soon JL, Agasthian T: Total tracheal resection for long- segment benign tracheal stenosis. Ann Thorac Surg 2008, 85:654-656. 3. Cuisnier O, Righini CH, Pison CH, Ferretti G, Revt E: Surgical and/or endoscopic treatment of acquired tracheal stenosis in adult patients. Ann Otolaryngol chir cervicofac 2004, 121:3-13. 4. Tsuchida M, Hashimoto T, Shiohara H, Hosaka Y, Koike T, Hayashi J: Tracheal resection and reconstruction for tracheal stenosis. Kyobu Geka 2008, 61:914-919. 5. Marulli G, Rizzardi G, Bortolotti L, Loy M, Breda C, Hamad AM: Single- staged laryngotracheal resection and reconstruction for benign strictures in adults. Interact Cardiovasc Thorac Surg 2008, 7:227-230. 6. Babarro Fernandez R, Martinez Moran A, Martinez Vidal J, Vazquez Barro JC, Sarandeses GA: Resection with end-to-end anastomosis for postintubation tracheal stenosis. Acta Otorrinolaringol Esp 2007, 58:16-19. 7. Wynn R, Har-El G, Lim JW: Tracheal resection with end- to-end anastomosis for benign tracheal stenosis. Ann Otol Rhinol Laryngol 2004, 113:613-617. 8. Behrend M, Klempnauer J: Influence of suture material and technique on end- to-end reconstruction in tracheal surgery: an experimental study in sheep. Eur Surg Reg 2001, 33:210-216. 9. Galluccio G, Lucantoni G, Battistoni P, Paone G, Batzella S, Lucifora V: Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long- term follow-up. Eur J Cardiothorac surg 2009, 35:429-433. 10. Nouraei SA, Kapoor KV, Nouraei SM, Ghufoor K, Howard DJ, Sandhu GS: Results of endoscopic tracheoplasty for treating tracheostomy related airway stenosis. Clin Otolaryngol 2007, 32:471-571-2. 11. Cavaliere S, Bezzi M, Toninelli C, Foccoli P: Management of post-intubation tracheal stenoses using the endoscopic approach. Monaldi. Arch Chest Dis 2007, 67:73-80. 12. Bagheri R, Fattahi SH, Banazadeh M: The role of tracheal stenting in the alternative treatment of tracheal stenosis. Iranian J Otorhinolaryngol 2005, 17:147-154. 13. Idriss FS, Deleon SY, Ilabawi MN, Gerson CR, Tucker GF, Holinger L. Tracheoplasty with pericardial patchfor extensive tracheal stenosis in infants and children. J Thorac Cardiovasc Surg 1984;88:527-536. 14. Bando K, Turrentine MW, Sun K, Sharp TG, Matt B, Heifetz SA, Stevens J, Kesler KA, Brown JW. Anterior pericardial tracheoplastyfor congenital tracheal stenosis: intermediate to long term outcomes. Ann Thorac Surg 1996;62:981-989. 15. Tsang V, Murday A, Gillbe C, Goldstraw P. Slide tracheoplasty for congenital funnel shaped tracheal stenosis. Ann Thorac Surg 1989;48:632-635. 16. Grillo HC. Slide tracheoplasty for long segment congenital tracheal stenosis. Ann Thorac Surg 1994;58:6113-6119. 17. Kimura K, Mukohara N, Tsugawa C et al. Tracheoplasty for congenital stenosis of entire trachea. J Pediatr Surg 1982;17:869-871.Abstract
References