Bronchoplastic techniques for pediatric lung salvage

Abstract

Bronchoplastic reconstruction can salvage normal bronchial and pulmonary tissue distal to diverse obstructive bronchial lesions. Five children underwent proximal bronchial and limited pulmonary resections allowing preservation of normal distal parenchyma. Three patients were infants between 2 1/2 and 12 months of age. All five survived without immediate or late complications. Follow-up included interval bronchoscopy and chest radiography, and ranged from 8 months to 12 years. Cardiopulmonary bypass was unnecessary even in the case of a large carinal lesion. Techniques used to insure adequate ventilation during bronchotomy included positioning the endotracheal tube above the carina with clamp occlusion of the open mainstem bronchus, positioning the tube within the opposite mainstem bronchus, and inserting a sterile tube into an open mainstem bronchus (with connections to sterile ventilator tubing passed across the operative field). Preoperative bronchoscopy and radiographic studies localized the extent and base of the lesion, allowing precise placement of the bronchotomy. Conservative excision was accomplished by frozen section examination of all margins of resection. Ingenious usage of available tissue was essential to a successful reconstruction.