Multidisciplinary approach to surgical treatment and rehabilitation of patients with defects of the anterior tracheal wall

The objective was to improve the results of treatment of patients with persistent defects of the anterior tracheal wall and soft tissues of the neck.Methods and materials. 220 patients with tracheal cicatrical stenosis were treated, of which 120 patients had defects of the anterior tracheal wall of various sizes. In 70% of cases, PCT was postintubation/posttracheostomy. Men predominated – 89 (74.2 %), women – 31 (25.8 %). After a routine examination, including endoscopic examination, MSCT of the chest with the capture of the cervical region, and general clinical diagnostic methods, all patients underwent surgical treatment.Results. According to the nature of the elimination of the defect of the anterior tracheal wall, patients were divided into several groups. Both local plastic surgery and the elimination of the tracheal defect with the use of microsurgical techniques were used. Circular resection of the trachea with the elimination of the defect was performed in 5 cases. In 2 cases, in the presence of a large persistent defect of more than 6 cm in size, a composite pre-fabricated deltopectoral skin-fascial-cartilage flap was used.Conclusion. The choice of a method for eliminating a persistent open defect of the anterior tracheal wall is determined individually in each case, it depends on its size, the depth of the airway lumen, and the condition of the surrounding tissues. The use of displaced skin-fascial flaps on the vascular pedicle for closing the tracheal defect allows to restore the mucous membrane of the tracheal defect area without using the surrounding scar tissue and close the defect with a second flap without straining the edges of the wound.

Evaluation of regenerated tracheal cilia function on a collagen-conjugated scaffold in a canine model

OBJECTIVES It is unclear whether the movement and function of the regenerated cilia on collagen-conjugated artificial trachea are the same as those of normal cilia. This study assessed the ciliary beat frequency (CBF) and ciliary transport functions (CTFs) of regenerated cilia in a canine model. METHODS A tracheal defect introduced into the anterior portion of the cervical trachea of an adult beagle dog was covered with a collagen-conjugated prosthesis. Two months later, the trachea was harvested along the long axis, both from normal and regenerated regions. The cilia were stained with isothiocyanate-conjugated wheat germ agglutinin, and their movement was monitored with a high-speed camera to analyse CBF and CTF. Four samples each were obtained from the regenerated and normal regions for CBF analysis and 7 samples each were obtained for CTF analysis. RESULTS The wheat germ agglutinin-stained cells showed well-regulated beats in both the regenerated and normal regions of the trachea. Mean CBF in the regenerated and normal regions did not differ significantly (7.11 ± 0.41 vs 7.14 ± 1.09 Hz; P = 981). By contrast, CTF was significantly lower in the regenerated region than in the normal region (30.0 ± 6.62 vs 7.43 ± 0.58 μm/s; P = 0.005). CONCLUSIONS Mean CBF in the regenerated and normal regions did not differ significantly at 2 months. The CTF in the regenerated region recovered partially but remained lower than those in the normal region. Methods are needed to improve the CTF of regenerated cilia.

Anesthetic Management for Emergent Repair of Tracheoinnominate Fistula

We present a case of a 30-year-old female, who had tracheostomy revision complicated by false passage into the subcutaneous space and pneumothorax. Six days later, she developed massive bleeding from the mouth, nose, and tracheostomy site. Approximately 2 liters of blood was lost. With high suspicion for tracheo-innominate fistula, she was emergently brought to the operating room for fistula repair. Her anesthetic management was initially focused on maintaining spontaneous ventilation with inhalation agents until surgical exposure was adequate. An endotracheal tube was then placed under guidance of a video-laryngoscope. The tracheostomy tube was then removed over a Cook catheter to maintain secure passage in case of airway collapse. The oral endotracheal tube was then inserted distal to the arterial and tracheal defect. The patient’s bleeding was stopped, the fistula was repaired, and she was transferred back to the intensive care unit, but she died several days later due to multi-organ failure.