Adjunctive Measures for Successful Laryngotracheal Reconstruction

1987 ◽  
Vol 96 (5) ◽  
pp. 509-513 ◽  
Author(s):  
Steven Gray ◽  
Charles M. Myer ◽  
Robert Miller ◽  
Robin T. Cotton
Keyword(s):  
Granulation Tissue ◽  
Reconstructive Surgery ◽  
Surgical Techniques ◽  
Laryngotracheal Stenosis ◽  
Surgical Tools ◽  
Diagnostic Skills ◽  
Laryngotracheal Reconstruction

The field of reconstructive surgery of the laryngotracheal complex has been the object of considerable enthusiasm in recent years. New surgical techniques, better surgical tools, and improved diagnostic skills all have contributed to a more confident approach to severe laryngotracheal stenosis. Just as the surgeon's judgment is crucial for a successful primary laryngotracheal reconstruction, so are his or her skill and judgment vitally important in managing the various problems that frequently are found following reconstructive surgery of the larynx and trachea. These problems, although seemingly minor, may prevent successful decannulation if not managed appropriately. This paper discusses the various problems that have been encountered while achieving decannulation following laryngotracheal reconstruction. An approach to such frustrating problems as suprastomal collapse, granulation tissue, and the inability to decannulate are presented.

scholarly journals A Modified Laryngeal Stent for Glotto-Subglottic Stenosis: A Novel Stent for Better Outcomes

2019 ◽  
pp. 014556131988307
Author(s):  
Jeffrey D. Wilcox ◽  
Michel Nassar
Keyword(s):  
Reconstructive Surgery ◽  
Subglottic Stenosis ◽  
Laryngotracheal Stenosis ◽  
Excellent Outcome ◽  
Laryngotracheal Reconstruction ◽  
And Function ◽  
Dependent Patient

Management of laryngotracheal stenosis is challenging and laryngotracheal stenosis is generally managed with laryngotracheal reconstruction. Stents are often used as part of the reconstructive surgery. Although most stents adequately stabilize the reconstruction during healing, they often do a poor job of mimicking glottic anatomy, particularly the anterior glottis. Here, we present a modified suprastomal stent designed to stabilize reconstruction after laryngotracheal reconstruction while also improving postoperative glottic anatomy and function. The case of a 15-year-old tracheostomy-dependent patient with glotto-subglottic stenosis who underwent laryngotracheal reconstruction using this modified stent is described. The patient had an excellent outcome with decannulation of her tracheostomy and significant improvement in voice.

scholarly journals Treatment of complex laryngotracheal stenosis in childhood–experience of a tertiary University Hospital from 2016 to 2019

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Melissa Ameloti Gomes Avelino ◽  
Laís da Silveira Botacin ◽  
Miguel Angel Corrales Coutinho
Keyword(s):  
Respiratory Failure ◽  
Demographic Data ◽  
Surgical Techniques ◽  
University Hospital ◽  
Laryngotracheal Stenosis ◽  
Pediatric Age ◽  
Endoscopic Dilation ◽  
Invasive Procedures ◽  
Laryngotracheal Reconstruction ◽  
Treatment Aspect

Abstract Background Laryngotracheal stenosis is a major cause of airway obstruction in pediatric age. The correction of such abnormality still remains a challenge, both because of anatomical issues in childhood and also due to the difficulty in having properly trained professionals and adequate hospital facilities. As treatment, many different surgical techniques are offered ranging from endoscopic and less invasive procedures to open surgeries, such as laryngotracheal reconstruction and cricotracheal resection. The treatment for complex laryngotracheal stenosis is considered successful when we have decannulation or resolution of respiratory failure with release from intensive care unit. Eighteen patients who were monitored at the pediatric otorhinolaryngology service between 2016 and 2019 were diagnosed with complex stenosis, with the collection of demographic data, comorbidities, degree of initial stenosis, post-treatment aspect, and whether or not decannulation occurred. Results Of the eighteen cases, three had congenital stenosis, fourteen had acquired stenosis, and one had mixed stenosis. Ages ranged from 4 months old to 15 years old. Six (33.3%) underwent endoscopic dilation procedures only, six (33.3%) underwent laryngotracheoplasty, and five (27.7%) cricotracheal resections. One patient underwent a slide tracheoplasty. Seven patients (38.8%) had to undergo more than one type of procedure to improve stenosis. Out of the eighteen patients, three of them were never tracheostomized. Of the remaining fifteen patients, fourteen (93.3%) were decannulated. Conclusions The success rate in decannulation or the resolution of respiratory failure with discharge from the ICU, after the procedures for correcting stenosis in childhood in our service, was 94.4%.

scholarly journals Laryngotracheal Stenosis Management: A 16-Year Experience

2019 ◽  
pp. 014556131987359 ◽  
Author(s):  
Jonathan Woliansky ◽  
Paul Paddle ◽  
Debra Phyland
Keyword(s):  
Treatment Outcome ◽  
Endoscopic Treatment ◽  
Chart Review ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Laryngotracheal Stenosis ◽  
Grade 3 ◽  
American Society

In recent years, it has become increasingly apparent that the laryngotracheal stenosis (LTS) cohort comprises distinct etiological subgroups; however, treatment of the disease remains heterogeneous with limited research to date assessing predictors of treatment outcome. We aim to assess clinical and surgical predictors of endoscopic treatment outcome for LTS, as well as to further characterize the disease population. A retrospective chart review of adult patients with LTS presenting over a 16-year period was conducted. Seventy-five patients were identified and subdivided into 4 etiologic subgroups: iatrogenic, idiopathic, autoimmune, and “other” groups. Statistical comparison of iatrogenic and idiopathic groups was performed. Subsequently, stepwise logistic regression was employed to examine the association between clinical/surgical factors and treatment outcome, as measured by tracheostomy incidence and dependence. We demonstrate that patients with iatrogenic LTS were significantly more morbid ( P < .001) and had worse disease, with significantly greater percentage stenosis ( P = .015) and increased incidence of tracheostomy ( P < .001). Analyzing the predictive effect of clinical and surgical variables on endoscopic treatment outcome, we have shown that when adjusted for age, sex, and iatrogenic etiology, patients with an American Society of Anesthesiologist score >2 were significantly more likely to undergo tracheostomy (adjusted odds ratio = 11.23, 95% confidence interval [CI] = 1.47-86.17). Similarly, when compared with their idiopathic counterparts, patients with iatrogenic LTS had higher odds of undergoing tracheostomy (17.33, 95% CI = 1.93-155.66) as were patients with Cotton-Myer grade 3-4 stenosis (9.84, 95% CI = 1.36-71.32). The odds of tracheostomy dependence at time of last follow-up were significantly higher in patients with gastroesophageal reflux disease (15.38, 95% CI = 1.36-174.43) and cerebrovascular accident (9.03, 95% CI = 1.01-81.08), even after adjustment. No surgical techniques were significantly associated with either outcome when adjusted. We present a heterogeneous LTS cohort comprised of homogeneous subgroups with distinct levels of morbidity, disease morphology, and treatment burden. Further our data suggest that the treatment outcome is more dependent on patient factors, rather than surgical technique used.

The History of Mastectomy

2011 ◽  
Vol 77 (5) ◽  
pp. 566-571 ◽  
Author(s):  
Marios Loukas ◽  
R. Shane Tubbs ◽  
Nadine Mirzayan ◽  
Michelle Shirak ◽  
Ashley Steinberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
20Th Century ◽  
Upper Limb ◽  
Breast Tissue ◽  
Surgical Techniques ◽  
Radical Mastectomy ◽  
Large Impact ◽  
Surgical Tools ◽  
History Of ◽  
Surgical Field

The mastectomy that is performed today is a procedure born from hundreds of years of discoveries, inventions, and amendments to existing surgical techniques. The reasons for performing this extreme surgery have changed as well, ranging from unilateral breast removal to allow greater upper limb functionality to bilateral removal of the breasts or breast tissue in individuals predisposed to breast cancer or in individuals who have already been diagnosed. The additions of surgical tools and anesthetics to the field of medicine further transformed the surgical field in general and had a large impact on the mastectomy. William Halsted's radical mastectomy served as the basis of most future breast removal techniques, and it the method recognized today as the “radical mastectomy.” Most radical surgeries are currently used for prophylaxis, whereas less invasive lumpectomies have eclipsed breast removal surgeries as of the latter half of the 20th century.

Computer Assisted Navigation Systems for Hip and Knee Reconstructive Surgery: Evaluation of Traditional Surgical Technique

2001 ◽  
Author(s):  
Anthony M. DiGioia ◽  
Frederic Picard ◽  
Branislav Jaramaz ◽  
David Sell ◽  
James C. Moody ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Patient Outcomes ◽  
Reconstructive Surgery ◽  
Surgical Navigation ◽  
Surgical Techniques ◽  
Measurement Tool ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Assisted Navigation ◽  
Surgical Navigation System

Abstract In this paper we describe a surgical navigation system named HipNav (Hip-Navigation) for THR and KneeNav (Knee-Navigation) for TKR with an emphasis on using these systems as a real time intraoperative measurement tool (these enabling technologies are the surgical toolbox of the future). This approach will permit the direct comparison of patient outcomes with measurable surgical techniques.

Laryngotracheal Reconstruction in the Pediatric Burn Patient: Surgical Techniques and Decision Making

2020 ◽  
Vol 41 (4) ◽  
pp. 882-886
Author(s):  
Asitha D L Jayawardena ◽  
Sarah Bouhabel ◽  
Robert L Sheridan ◽  
Christopher J Hartnick
Keyword(s):  
Decision Making ◽  
Multidisciplinary Approach ◽  
Burn Injury ◽  
Surgical Techniques ◽  
Surgical Decision ◽  
Laryngotracheal Reconstruction ◽  
Unaffected Skin ◽  
Surgical Decision Making ◽  
Insight Into ◽  
Burn Patient

Abstract The management of laryngotracheal stenosis (LTS) in the pediatric burn patient is complex and requires a multidisciplinary approach. The mainstay of treatment for LTS is laryngotracheal reconstruction (LTR), however, limited reports of burn-specific LTR techniques exist. Here, we provide insight into the initial airway evaluation, surgical decision making, anesthetic challenges, and incision modifications based on our experience in treating patients with this pathology. The initial airway evaluation can be complicated by microstomia, trismus, and neck contractures—the authors recommend treatment of these complications prior to initial airway evaluation to optimize safety. The surgical decision making regarding pursuing single-stage LTR, double-stage LTR, and 1.5-stage LTR can be challenging—the authors recommend 1.5-stage LTR when possible due to the extra safety of rescue tracheostomy and the decreased risk of granuloma, which is especially important in pro-inflammatory burn physiology. Anesthetic challenges include obtaining intravenous access, securing the airway, and intravenous induction—the authors recommend peripherally inserted central catheter when appropriate, utilizing information from the initial airway evaluation to secure the airway, and avoidance of succinylcholine upon induction. Neck and chest incisions are often within the TBSA covered by the burn injury—the authors recommend modifying typical incisions to cover unaffected skin whenever possible in order to limit infection and prevent wound healing complications. Pediatric LTR in the burn patient is challenging, but can be safe when the surgeon is thoughtful in their decision making.

Microvascular nose reconstruction after extended tumor resection.

2020 ◽  
Vol 92 (4) ◽  
pp. 1-5
Author(s):  
Łukasz Krakowczyk
Keyword(s):  
Free Flap ◽  
Reconstructive Surgery ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Nasal Reconstruction ◽  
Radial Forearm Free Flap ◽  
Treatment Standards ◽  
Anatomical Region ◽  
Nasal Tumors ◽  
Radial Forearm

Introduction: The nose is the central and probably the most important anatomical region of the face. Reconstructive surgery after tumor resection in this anatomical region requires from the surgeon knowledge of the anatomy, due to the three-dimensional shape and variety of tissues. Materials and methods: In the years 2010-2019, 48 patients were treated in the Oncological and Reconstructive Surgery Clinic for extended nasal tumors , who required the use of free microvascular flaps after resection for functional and aesthetic supply of anatomical structures of the nose. Results: In 48 patients, a total of 92 free microvascular flap were used for nasal reconstruction including: radial forearm free flap in 24 patients, radial forearm free flap with radial bone in 14 patients, auricle free flap in 16 patients, radial forearm free flap in combination with auricle free flap in 7 patients, double auricle free flap in 6 patients, radial forearm free flap in combination with double auricle free flap in 4 patients. Total necrosis of the free flap was noted in 4 cases, partial in 6 patients. Conclusions: Presented surgical techniques using the microvascular free flaps constitute a recognized method of treatment in the world and should be used in everyday surgeon practice. Discussion: In the reconstructive nose surgery after extended tumor resections due to cancer, there are no uniform treatment standards and algorithms . The surgeon is often dependent on his knowledge, skills and creative thinking . Presented results in this article allows to obtain optimal functional and aesthetic effects.

Minimal Invasive Surgery and Therapy (MIS and MIT) in Hirschsprung's Patients

2008 ◽  
pp. 882-889
Author(s):  
Nilmini Wickramasinghe ◽  
Giuseppe Turchetti ◽  
Barbara Labella ◽  
Andrea Moglia ◽  
Arianna Menciassi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Invasive Surgery ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Surgical Techniques ◽  
Diagnostic Procedures ◽  
Minimal Invasive ◽  
Surgical Tools ◽  
Economic Perspectives ◽  
Laparoscopic Tools

The generally accepted treatment for Hirschsprung’s disease is through surgical intervention. Currently, the recognized techniques include the Swenson technique, which is less frequently used as the operation is delicate and can give rise to complications; the Duhamel technique, which is arguably the simplest approach and consistently provides good results; and the Soave technique, which also provides good results but is often more complex than the Duhamel approach. However, surgical and diagnostic procedures of the future will evolve from embracing current technologies that enable minimally invasive approaches to extremely targeted, localized, and high-precision endoluminal techniques. This requires entirely new types of surgical tools capable of entering the human body through natural orifices (by insertion, ingestion, or inhalation), very small incisions (injections), or even through skin absorption and maybe configuring themselves in complex kinetic structures at the specific site of intervention. Moreover, such approaches necessitate modification of classic surgical techniques. While the advantages of minimally invasive surgery and minimally invasive therapy (MIS and MIT) are widely acknowledged, this chapter serves to highlight the advantages of such procedures in pediatric medicine, both at the diagnostic and intervention levels and the consequent implications to classic surgical techniques. The particular focus of the chapter pertains to the specific advantages the following techniques can bring into pediatric diagnostic and surgical techniques in the case of Hirschsprung’s disease: (1) endoluminal miniaturized tools for gastrointestinal endoscopy, (2) gastrointestinal capsules for digestion (e.g., M2A capsule), and (3) laparoscopic tools for surgery. Both technological and economic perspectives are discussed.

Laryngotracheal augmentation using titanium mesh

2007 ◽  
Vol 122 (4) ◽  
pp. 391-396 ◽  
Author(s):  
A A Gaafar ◽  
A A El-Daly ◽  
H A Gaafar
Keyword(s):  
Granulation Tissue ◽  
Standard Treatment ◽  
Good Alternative ◽  
Scar Tissue ◽  
Laryngotracheal Stenosis ◽  
Rigid Support ◽  
Titanium Mesh ◽  
Tracheal Lumen ◽  
Titanium Plate ◽  
T Tube

AbstractBackground:The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment.Study design:Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic®stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken.Results:Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation was impossible in two cases, one due to excessive granulation tissue and the other due to prolapse of the titanium mesh into the tracheal lumen (the mesh was removed endoscopically and a Montgomery T-tube inserted).Conclusion:Titanium mesh was found to be a good alternative for augmentation of the anterior laryngotracheal wall. It offered rigid support, with fewer of the complications reported with other grafts.

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