Treatment of large tracheal defects after resection: Laryngotracheal release and tracheal replacement

Publication date: Available online 14 April 2016
Source:Auris Nasus Larynx
Author(s): Andreas Kirschbaum, Afshin Teymoortash, Carlos Suárez, Jatin P. Shah, Carl E. Silver, Iain Nixon, Alessandra Rinaldo, Luiz P. Kowalski, K. Thomas Robbins, Alfio Ferlito
ObjectiveResection with direct tracheal or laryngotracheal anastomosis is the standard procedure employed for treatment of benign stenosis or occasionally primary or secondary tracheal malignancy.Data sourcesLiterature review.ResultsA tracheal anastomosis usually heals without complications provided that the ends being joined are adequately supplied with blood, an atraumatic suturing technique is used, and the anastomosis does not become infected. It is especially important that the anastomosis is not subjected to tension.ConclusionVarious techniques of laryngeal and tracheal release serve to reduce the tension on the anastomosis by mobilizing and reducing the distance between the two segments to be approximated. These techniques can be used in different combinations depending on situation encountered during surgery. In cases where more than 50% of the tracheal length must be excised, prosthetic replacements, autologous tissue transfer and allografts are required. All present various problems. The use of tissue-engineering techniques utilizing autologous stem cells has opened new perspectives for tracheal replacement. Such procedures are still in an experimental state.



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