Abstract
In this issue of The Annals, covered expandable stents are offered for management of “tracheal granulation tissue” where tracheal resection is not possible [1]. We have recently been referred a number of patients with postintubation tracheal stenosis—characterized in earlier postulcerative stages by profuse granulation tissue— who were treated with expandable, uncovered stents. The inevitable followed. Granulations grow through the interstices of the stent incorporating the stent into the tracheal wall. The consequent obstruction becomes difficult to manage, even palliatively, with laser. It is often impossible to remove the offending stent bronchoscopically, and sometimes difficult even by open total linear tracheotomy. What is almost incomprehensible is that this outcome was not evident in advance to the surgeon.
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