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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 604-612, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WE Neville, JP Bolanowski and GG Kotia
The superiority of using the patient's own tissue for tracheal
reconstruction is acknowledged. When this is impossible an alternate method
is mandatory. From 1970 to 1988, 62 patients with benign and malignant
tracheal stenosis had airway continuity established with a silicone tube. A
straight graft was used in 48 patients. Twenty-eight had strictures, two
tracheoesophageal fistulas and strictures, five primary malacia, and 13
malignant tumors. In 20 with noncancerous tracheal obstruction the airway
was resected and a graft interposed. Distal suture line granulomas
developed in six of these patients. Two had subglottic granulomas. One had
graft dehiscence after dissolution of absorbable suture material. This
graft was replaced with a silicone T tube. Four patients with end-to-end
anastomosis of the graft to the trachea died in 6 to 12 months. Six others
were lost to follow-up. In 15 of the 48 with benign disease the stent was
placed within the lumen. Six in this group died. Thirteen of the 48
patients had a malignant tumor. In six the tube was used for palliation;
none are alive. Seven underwent resection; five are living 1 to 8 years
after the operation, two died of their disease in 1 1/2 to 2 years, and two
of the five living are undergoing irradiation for recurrent cancer.
Fourteen individuals with tracheocarinal malignancy received a bifurcated
graft. All six patients with a palliative intraluminal stent died. Among
eight individuals, four died of disease in 1 to 4 years. Four are alive,
but two have suture line granulomas and two are undergoing irradiation for
residual carcinoma. Mediastinal infection, mucus encrustations of the
intraluminal prosthesis, and impedence of pulmonary secretions across long
tubular segments have not been manifest. These silicone tubes are well
tolerated and function satisfactorily as an airway.
ARTICLES
Clinical experience with the silicone tracheal prosthesis
UMDNJ-New Jersey Medical School, Newark.
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