Application of Surgiflo® in Tracheal Resection Anastomosis: Not Just a Hemostatic Agent But May Have a Potential Impact on the Healing Process

Abstract

Background: Partial cricotracheal resection (PCTR) is considered the treatment of choice for high grade subglottic/tracheal stenosis. One of the principal surgical concern is non-tension water tight anastomosis with proper healing. Surgiflo® (Ethicon, Somerville, USA) is a commonly and safely used active flowable hemostatic matrix that may cause significant histopathological alterations, such as inflammation, adhesion and fibrosis, which may facilitate healing at the anastomotic site. Methods: We have reviewed our experience in Mansoura University Hospitals, Egypt; with the use of Surgiflo® in cases of PCTR. This study included 1 female patient with upper tracheal adenoid cystic carcinoma and 11 male patients with severe post-traumatic subglottic/tracheal stenosis. Significant comorbidities were reported in 6 adult patients (50%) in the form of neurological problems (n=3), COPD (n=2), OSAS (n=1), unilateral vocal fold paralysis (n=1) and morbid obesity (n=2). Eight patients (66.7%) had a history of previous airway surgery. The adopted surgical technique was standardized by the authors for all patients and Surgiflo® was applied at the end of surgery over the whole operative field including the anastomotic area. Findings: At the end of proper surgical intervention, 11 patients were successfully extubated with effortless breathing. None of the frequently reported complications like granulation tissue formation at the site of anastomosis, restenosis, surgical emphysema requiring intervention or wound seroma were reported in this series. On a follow up period of 6 - 12 months, 91.7% of the studied patients didn't have any further surgical intervention and all of them returned to their usual life activity. Interpretation: Direct Surgiflo® application in the operative field can be recommended as an adjuvant to surgery in patients undergoing PCTR especially when associated with comorbidities. Funding Statement: The authors stated: No. Declaration of Interests: No competing interest to declare. Ethics Approval Statement: A written consent was obtained from either the patient or the patient’s guardian. The study was approved by Mansoura faculty of Medicine Institutional Research Board (IRB: R.19.08.597).