Reconstructive Surgery for Tracheal Trauma

Abstract

1) Referring to a large literature published up to 1963 in the world, 362 tracheo-bronchial plasty cases were commented on statistically. Traumatic injury was the major cause in 113 cases and ranked first. Traumatic injury following a traffic accident has been increasing recently in number. Site of injury was mostly found in the trachea, especially the cervical trachea. Follow-up studies revealed successful recovery in 86% of the cases operated in an early stage and in 72% of that operated rather late. Concerning to the method of surgery, the results of the suture method and the resection-anastomosis method were both satisfactory, that of the transplantation and prosthesis ended mostly in failure except the patch graft method.2) We experienced 22 cases of tracheo-bronchial plasty in Keio University Hospital. Four cases of them who had undergone cervical tracheal plasty were reported in detail.3) In order to study the limitation in length of tracheal resection, Dr. Koizumi of our Surgical Department mesured extensibility of the trachea by means of bronchography. He reported that the physiologically natural extensibility of the trachea was 22.7% of its total length and the trachea of the adult extended 26mm on the average. He also measured extensibility of corpses' resected tracheas and found that the extensibility was definitely in inverse proportion to the age. In this study the extensibility was 41.6% in the teenagers, 17.2% in the sixties, and 24.3% on the average. From the results of his study it is concluded that the standard limitation of tracheal resection is 2.5cm in length and that an amount to be resected has to be decided in accordance to pulmonary lesions and an age of a patient.4) The author, finally, reported the results of his animal experiments on tracheal reconstructive surgery. Reconstruction using “PAIREN” mesh and fascia is the best among other various methods of prosthesis. Satisfactory results were obtained in 60% of the cases using pedicled tracheal cartilages as a support and 56% of the cases using horse-shoe shaped steel wire. These results give us the bright prospects for tracheal prosthesis in clinical use.