Repair of long-segment tracheomalacia with free autologous cartilage ring grafts

Abstract

Tracheomalacia involving the whole of the trachea is uncommon and difficult to manage. We report a child with oesophageal atresia and tracheo-oesophageal fistula who presented in the immediate postnatal phase with severe respiratory embarrassment that was relieved by endotracheal intubation with a long tube. The trachea, which was totally devoid of cartilage, was reconstructed to simulate normal tracheal anatomy. Eleven free autologous costal cartilage grafts were consecutively disposed in ring fashion between the cricoid cartilage and the carina. No tracheostomy was required. We recommend consideration of this technique for tracheal reconstruction without tracheostomy in the neonate with extensive or severe tracheomalacia, primarily or following failure of other procedures.