Novel Repair Technique of Transmural Tracheal Lacerations

Abstract

Objective: 1) Demonstrate a novel method to repair a full thickness tracheal wall laceration. 2) Discuss the relationship of this new technique in regard to current accepted methods of treatment reported in the literature. 3) Learn that full thickness tracheal tears, although rare, are possible following routine tracheal balloon dilation. Method: We review a patient’s case of symptomatic idiopathic subglottic stenosis. One year after initial dilation, balloon dilation was performed and an 8-cm full-thickness tracheal laceration occurred. We report successful repair with a covered tracheobronchial stent and review the literature relating our repair to other accepted techniques. Results: Following tracheal balloon dilation, staying within recommended limits, a complete tear was identified. Using flexible endoscopy and fluoroscopic guidance the tear was measured to be 8 cm. An 80 × 20 mm covered tracheobronchial stent was deployed into position to overlie the area of tracheal disruption. Intraoperative computed tomography demonstrated minimal air extravasation, thus the patient was extubated. The patient’s course was uncomplicated and discharged three days later. Review of current literature demonstrates a variety of repair techniques including soft tissue reconstruction. Our technique is advantageous because it can be done at the time of surgery with excellent outcomes and less morbidity. Conclusion: Endotracheal balloon dilation is an established and safe method to restore airway volume; however full thickness lacerations can occur. This case demonstrates that deployment of an appropriate tracheobronchial stent at the time of surgery is a viable treatment option with low comorbidity. Close postoperative monitoring is vital to successful outcome.