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

Published:April 14, 2016DOI:https://doi.org/10.1016/j.anl.2016.03.009

      Abstract

      Objective

      Resection with direct tracheal or laryngotracheal anastomosis is the standard procedure employed for treatment of benign stenosis or occasionally primary or secondary tracheal malignancy.

      Data sources

      Literature review.

      Results

      A 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.

      Conclusion

      Various 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.

      Keywords

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      References

        • Hecker E.
        • Volmerig J.
        Extended tracheal resections.
        Thorac Surg Clin. 2014; 24: 85-95
        • Behrend M.
        • Klempnauer J.
        Tracheal reconstruction under tension: an experimental study in sheep.
        Eur J Surg Oncol. 2001; 27: 581-588
        • Maeda M.
        • Grillo H.C.
        Effect of tension on tracheal growth after resection and anastomosis in puppies.
        J Thorac Cardiovasc Surg. 1973; 65: 658-668
        • Schilt P.N.
        • McRae B.R.
        • Akkus O.
        • Cordes S.R.
        • Halum S.L.
        An experimental model to investigate initial tracheal anastomosis strength.
        Laryngoscope. 2010; 120: 1125-1128
        • Grillo H.C.
        • Dignan E.F.
        • Miura T.
        Experimental reconstruction of cervical trachea after circumferential resection.
        Surg Gynecol Obstet. 1966; 122: 733-738
        • Wang H.
        • Wright C.D.
        • Wain J.C.
        • Ott H.C.
        • Mathisen D.J.
        Idiopathic subglottic stenosis: factors affecting outcome after single-stage repair.
        Ann Thorac Surg. 2015; 100: 1804-1811
        • Grillo H.C.
        • Dignan E.F.
        • Miura T.
        Extensive resection and reconstruction of mediastinal trachea without prosthesis or graft: an anatomical study in man.
        J Thorac Cardiovasc Surg. 1964; 48: 741-749
        • Rosen F.S.
        • Pou A.M.
        • Buford W.L.
        Tracheal resection with primary anastomosis in cadavers: the effects of releasing maneuvers and length of tracheal resection on tension.
        Ann Otol Rhinol Laryngol. 2003; 112: 869-876
        • Weidenbecher M.
        • Gentsch H.
        [The treatment of tracheal stenosis by segmental resection (author's transl)].
        HNO. 1980; 28: 336-342
        • Dedo H.H.
        • Fishman N.H.
        Laryngeal release and sleeve resection for tracheal stenosis.
        Ann Otol Rhinol Laryngol. 1969; 78: 285-296
        • Grillo H.C.
        • Donahue D.M.
        • Mathisen D.J.
        • Wain J.C.
        • Wright C.D.
        Postintubation tracheal stenosis. Treatment and results.
        J Thorac Cardiovasc Surg. 1995; 109 ([discussion 492–3]): 486-492
        • Maassen W.
        [Laryngeal release for tracheal resection (author's transl)].
        Thoraxchir Vask Chir. 1978; 26: 291-296
        • Komori K.
        • Toma M.
        • Shimojima N.
        • Yamamoto Y.
        • Uto K.
        • Ogata S.
        • et al.
        Laryngeal release with slide tracheoplasty for long-segment congenital tracheal stenosis.
        Gen Thorac Cardiovasc Surg. 2015; 63: 583-585
        • Montgomery W.W.
        Suprahyoid release for tracheal anastomosis.
        Arch Otolaryngol. 1974; 99: 255-260
        • El-Fattah A.M.
        • Kamal E.
        • Amer H.E.
        • Fouda M.
        • Elwahab A.E.
        • Tawfik A.
        Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III-IV tracheal stenosis.
        J Laryngol Otol. 2011; 125: 614-619
        • Kang J.H.
        • Park I.K.
        • Bae M.K.
        • Hwang Y.
        Mediastinoscopic bilateral bronchial release for long segmental resection and anastomosis of the trachea.
        Korean J Thorac Cardiovasc Surg. 2011; 44: 257-259
        • Heitmiller R.F.
        Tracheal release maneuvers.
        Chest Surg Clin N Am. 1996; 6: 675-682
        • Kirschbaum A.
        • Teymoortash A.
        Video mediastinoscopically assisted tracheal release in treatment of long tracheal stenosis.
        Thorac Cardiovasc Surg Rep. 2013; 2: 32-34
        • Watanabe S.
        • Takagi K.
        • Nakamura Y.
        • Sakata R.
        Tracheal release and thymus wrapping of the tracheoplasty anastomosis through mini-sternotomy.
        Eur J Cardiothorac Surg. 2004; 25: 287-289
        • Fujimoto T.
        • Zaboura G.
        • Fechner S.
        • Hillejan L.
        • Schroder T.
        • Marra A.
        • et al.
        Completion pneumonectomy: current indications, complications, and results.
        J Thorac Cardiovasc Surg. 2001; 121: 484-490
        • Friedel G.
        • Kyriss T.
        • Leitenberger A.
        • Toomes H.
        Long-term results after 110 tracheal resections.
        Ger Med Sci. 2003; 1 (Doc10)
        • Czigner J.
        • Rovo L.
        • Brzozka M.
        Circumferential resection of crico-tracheal stenosis with primary end-to-end anastomosis.
        Otolaryngol Pol. 2004; 58: 149-155
        • Andreoli S.M.
        • Nguyen S.A.
        • White D.R.
        Feeding status after pediatric laryngotracheal reconstruction.
        Otolaryngol Head Neck Surg. 2010; 143: 210-213
        • Sywak M.
        • Pasieka J.L.
        • McFadden S.
        • Gelfand G.
        • Terrell J.
        • Dort J.
        Functional results and quality of life after tracheal resection for locally invasive thyroid cancer.
        Am J Surg. 2003; 185: 462-467
        • Gaissert H.A.
        • Honings J.
        • Grillo H.C.
        • Donahue D.M.
        • Wain J.C.
        • Wright C.D.
        • et al.
        Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma.
        Ann Thorac Surg. 2007; 83: 1952-1959
        • Merati A.L.
        • Rieder A.A.
        • Patel N.
        • Park D.L.
        • Girod D.
        Does successful segmental tracheal resection require releasing maneuvers?.
        Otolaryngol Head Neck Surg. 2005; 133: 372-376
        • Cordos I.
        • Bolca C.
        • Paleru C.
        • Posea R.
        • Stoica R.
        Sixty tracheal resections – single center experience.
        Interact Cardiovasc Thorac Surg. 2009; 8 ([discussion 65]): 62-65
        • Zannini P.
        • Melloni G.
        • Carretta A.
        • Ciriaco P.
        • Canneto B.
        • Puglisi A.
        • et al.
        [Laryngotracheal resection and reconstruction by Grillo's technic for postintubation stenosis].
        Minerva Chir. 1999; 54: 107-116
        • Har-El G.
        • Shaha A.
        • Chaudry R.
        • Lucente F.E.
        Resection of tracheal stenosis with end-to-end anastomosis.
        Ann Otol Rhinol Laryngol. 1993; 102: 670-674
        • Taylor J.C.
        • Collar R.M.
        • Wilson K.F.
        • Ohye R.G.
        • Green G.E.
        Cricotracheal resection with hilar release for pediatric airway stenosis.
        Arch Otolaryngol Head Neck Surg. 2010; 136: 256-259
        • Donahue D.M.
        • Grillo H.C.
        • Wain J.C.
        • Wright C.D.
        • Mathisen D.J.
        Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis.
        J Thorac Cardiovasc Surg. 1997; 114 ([discussion 938–9]): 934-938
        • Krajc T.
        • Janik M.
        • Benej R.
        • Lucenic M.
        • Majer I.
        • Demian J.
        • et al.
        Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases.
        Interact Cardiovasc Thorac Surg. 2009; 9: 983-989
        • Delaere P.
        • Vrancks J.
        • Verleden G.
        • de Leyn P.
        • van Raemdonck D.
        [Tracheal allotransplantation after withdrawal of immunosuppressive therapy].
        Bull Acad Natl Med. 2010; 194 ([discussion 1337]): 1335-1337
        • Delaere P.R.
        • Vranckx J.J.
        • Meulemans J.
        • Vander Poorten V.
        • Segers K.
        • Van Raemdonck D.
        • et al.
        Learning curve in tracheal allotransplantation.
        Am J Transplant. 2012; 12: 2538-2545
        • Makris D.
        • Holder-Espinasse M.
        • Wurtz A.
        • Seguin A.
        • Hubert T.
        • Jaillard S.
        • et al.
        Tracheal replacement with cryopreserved allogenic aorta.
        Chest. 2010; 137: 60-67
        • Wurtz A.
        • Porte H.
        • Conti M.
        • Dusson C.
        • Desbordes J.
        • Copin M.C.
        • et al.
        Surgical technique and results of tracheal and carinal replacement with aortic allografts for salivary gland-type carcinoma.
        J Thorac Cardiovasc Surg. 2010; 140: 387-393
        • Dikina A.D.
        • Strobel H.A.
        • Lai B.P.
        • Rolle M.W.
        • Alsberg E.
        Engineered cartilaginous tubes for tracheal tissue replacement via self-assembly and fusion of human mesenchymal stem cell constructs.
        Biomaterials. 2015; 52: 452-462
        • Teoh G.Z.
        • Crowley C.
        • Birchall M.A.
        • Seifalian A.M.
        Development of resorbable nanocomposite tracheal and bronchial scaffolds for paediatric applications.
        Br J Surg. 2015; 102: e140-e150
        • Elliott M.J.
        • De Coppi P.
        • Speggiorin S.
        • Roebuck D.
        • Butler C.R.
        • Samuel E.
        • et al.
        Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study.
        Lancet (London, England). 2012; 380: 994-1000
        • Hamilton N.J.
        • Kanani M.
        • Roebuck D.J.
        • Hewitt R.J.
        • Cetto R.
        • Culme-Seymour E.J.
        • et al.
        Tissue-engineered tracheal replacement in a child: a 4-year follow-up study.
        Am J Transplant. 2015; 15: 2750-2757
        • Macchiarini P.
        • Jungebluth P.
        • Go T.
        • Asnaghi M.A.
        • Rees L.E.
        • Cogan T.A.
        • et al.
        Clinical transplantation of a tissue-engineered airway.
        Lancet (London, England). 2008; 372: 2023-2030
        • Jungebluth P.
        • Alici E.
        • Baiguera S.
        • Le Blanc K.
        • Blomberg P.
        • Bozoky B.
        • et al.
        Tracheobronchial transplantation with a stem-cell-seeded bioartificial nanocomposite: a proof-of-concept study.
        Lancet (London, England). 2011; 378: 1997-2004
        • Kojima K.
        • Vacanti C.A.
        Tissue engineering in the trachea.
        Anat Rec. 2014; 297: 44-50
        • Teng M.S.
        • Malkin B.D.
        • Urken M.L.
        Prefabricated composite free flaps for tracheal reconstruction: a new technique.
        Ann Otol Rhinol Laryngol. 2005; 114: 822-826