Intraoperative Methods Research Articles

Pediatric neuroanesthesia experiences: A single center retrospective cohort study

Background/Aim: Pediatric neuroanesthesia is a special field that requires significant experience and infrastructure because of anatomical, neurological, and pharmacological differences in the pediatric patient population. Although technological improvements provide more effective and safer neuroanesthesiological management, the principles of neuroanesthesia, neurocognitive development, and the effects of anesthetic agents on central nervous system development are well-known. The majority of pediatric neuroanesthesia articles in the literature are reviews; however, retrospective/prospective case series and controlled research are limited. In this retrospective cohort study, we aimed to contribute to the existing literature by reviewing and analyzing our single-center 10-year experiences and results addressing pediatric neuroanesthesia management. Methods: After ethical committee approval, anesthetic and surgical reports from 1165 pediatric neurosurgical cases over ten years were collected. Demographic data, intra-operative vascular management, anesthesia techniques, airway management, patient positions, analgesia methods, and complications were evaluated in this retrospective cohort study. The available surgical intervention, patient positions, intra-operative neuromonitorization (IONM), and intra-operative magnetic resonance imaging (IOMR) records were also analyzed. Results: Six-hundred forty-six (55.4%) girls and 519 (44.5%) boys were included in the study. The median age was 60 (0–216) months. Cranial interventions were performed in 842 (72.3%) patients, and spinal interventions were performed in 323 (27.7%) patients. Patients’ American Society of Anesthesiologists (ASA) physical scales grouped as I, II, III, and IV were 718 (61.6%), 360 (30.9%), 82 (7%), and 5 (0.4%), respectively. Sevoflurane (40.3%), propofol (37.2%), and sodium thiopental (2.5%) were used for anesthetic induction. Neuromuscular block was performed with rocuronium (56.7%) and atracurium (14.4%). Neuromuscular blocking agents were not used in 337 patients (28.9%). A blood transfusion was required in 120 patients (10.3%), and 40% of these patients underwent surgery for craniosynostosis. Two-hundred twenty-two (19.1%) were monitored with IONM, and IOMR was carried out in 124 (10.6%) of the cases. The anesthesia-related complication rate was 5.15% (60 patients). Conclusion: Although pediatric neurosurgical interventions involve high risks, they are becoming increasingly common in our daily practice. Neuroanesthesiologists should know the procedures, techniques, and advances for safe and effective management of pediatric neurosurgical cases. We think that these data may be helpful as a guide for the anesthetic management of pediatric neurosurgical cases.

Removal of migrated intrauterine device embedded in the urinary bladder wall complicated with cystitis glandularis by a combination of laparoscopy and cystoscopic assistance and literature review

Objective: To explore the mechanism and prevention measures of calculi and adenular cystitis because of IUCD bladder ectopic. Method: Clinical data of one patient with IUCD bladder ectopic cystitis were collected, and the main history, examination data, intraoperative surgical methods and postoperative follow-up were also retrospectively analyzed. Result: The patient recovered well after surgery, without recurrent urinary tract infection after 1 year of follow-up, and recovered from sexual life. Conclusion: IUD allotopic and adenandular cystitis requires complete resection of the lesion, and laparoscopic combination with cystoscopy has obvious results.

Comparison of intraoperative neurophysiological monitoring methods for lumbosacral lipoma surgery in infants.

Stable intraoperative neurophysiology monitoring of infants, especially very young infants, is challenging. In this study, motor evoked potentials (MEPs), the bulbocavernosus reflex (BCR), and somatosensory evoked potentials (SEPs) were simultaneously monitored in infants with lumbosacral lipomas, and these methods were compared retrospectively. A total of 21 surgeries performed for lumbosacral lipoma in patients less than 1year old were studied. The mean age at surgery was 133.8days (range 21-287days; ≤ 120days: 9 cases, > 120days: 12 cases). Transcranial MEPs were measured in the anal sphincter and gastrocnemius, and tibialis anterior and other muscles were added as needed. The BCR was measured by the electromyogram of the anal sphincter muscle with stimulation of the pubic region, and SEPs were measured from the waveforms of stimulation of the posterior tibial nerves. For the BCR, stable potentials could be recorded for all 9 cases at ≤ 120days of age. In contrast, for MEPs, stable potentials could be recorded in only 4 of 9 cases (p < 0.05). For all patients > 120days of age, MEPs and the BCR were measurable. SEPs were undetectable in some patients regardless of age. The BCR could be more consistently measured than MEPs in infant patients with lumbosacral lipoma at ≤ 120days of age.

Trochanteric and subtrochanteric fractures irreducible by closed reduction: a retrospective study

AimTo explore the preoperative radiographic features and reduction methods of irreducible trochanteric and subtrochanteric fractures of the femur and to compare the perioperative characteristics and prognoses of irreducible and reducible fractures.MethodsThe data of 1235 patients with femoral trochanteric fractures surgically treated in our hospital between January 2010 and January 2021 were retrospectively analyzed. According to the inclusion criteria and exclusion criteria, 1163 cases of femoral trochanteric and subtrochanteric fractures were included in this study. Fractures in which good or acceptable reduction could not be reached by closed manipulation were defined as irreducible fractures. The preoperative radiographic features, fracture displacement patterns after closed manipulation and intraoperative reduction methods used to treat irreducible fractures were analyzed, and the perioperative characteristics and prognoses of irreducible fractures and reducible fractures were compared.ResultsThere were 224 patients in the irreducible group and 939 patients in the reducible group. According to the radiographic features of fractures, irreducible fractures could be divided into four types: those with interlocking of the fracture, sagging of the femoral shaft, splitting of the lateral wall or medial wall, and comminution of the subtrochanteric area. Various kinds of reduction techniques were needed for different types.ConclusionsThe incidence of irreducible trochanteric fractures was 15.4%, while the incidence of irreducible subtrochanteric fractures was 84.6%. According to the radiographic features of fractures, they can be divided into four types. It is important to identify irreducible fractures preoperatively and make comprehensive plans to the greatest extent possible to shorten the operation time, reduce intraoperative blood loss, and reduce the incidence of complications.

Potential benefits of intraoperative ultrasound in neurosurgery.

Computed tomography and magnetic resonance imaging are the most popular diagnostic tools to visualize intracranial pathology and help surgical planning in the neurosurgical practice. However, these preoperative techniques need to be supplemented with intraoperative methods, if the lesion size may increase or preoperative anatomy may change after the primary imaging due to rapid progression of the underlying intracranial disease. In such situations intraoperative ultrasound could be a valuable technique in real-time imaging of intracranial pathologic processes, real-time control of surgical procedure, assistance in drain or catheter placement, and real-time assessment of residual tumor or hematoma volume during neurosurgical interventions.

Persistent and Recurrent Primary Hyperparathyroidism: Intraoperative Supplemental Methods, Basic Principles of Surgery, and Other Treatment Options.

Reoperative parathyroid surgery is challenging even for experienced surgeons. Cure rates are lower than primary surgery. Good anatomical and embryological knowledge is important. Preoperatively, a comprehensive surgical strategy should be planned. Pre-operative imaging modalities should be used extensively to find the overlooked gland to have a possibility to perform focused parathyroid surgery to avoid possible complications. One of the important developments is the new ancillary methods to find overlooked parathyroid glands. Orthotopic and possible ectopic locations should be known well by the surgeon to increase the surgical success rate. Reoperative parathyroid surgery needs a distinctive approach compared to primary parathyroid surgery. Basic principles include the selection of the incision and route for entering the thyroid region, use of ancillary methods, and intraoperative nerve monitoring and also require a meticulous dissection. Obtaining a surgical cure is difficult and high surgical caution is needed. Post-operative complication rates are higher compared to primary parathyroid surgery. Other treatment methods and medical treatment options may be evaluated in a patient who cannot undergo surgery.

S-55-5: CT GUIDED AND TRANSVENOUS RADIOFREQUENCY ABLATION FOR PRIMARY ALDOSTERONISM

We are developing minimally invasive treatments for primary aldosteronism. In this presentation, we will introduce our research and clinical studies on percutaneous and transvenous radiofrequency ablation (RFA). Based on the preclinical studies, a protocol for ablating human adrenal glands and intraoperative blood pressure control methods were developed. First-in-human procedure was performed. Flexible RFA catheter was inserted into the upper lateral tributary of the left adrenal vein. The position of the RFA catheter was confirmed by CT. Ablations were performed while applying energy of 7000 J twice to each location, pulling back the catheter several millimeters in sequence. The aldosterone-producing adenoma was completely ablated to normalize the serum aldosterone level. CT-guided RFA was able to treat PA with a high success rate. However, approximately 50% of the left aldosterone producing adenomas were difficult to puncture due to anatomical reason, while most of the right adrenal adenoma could be treated by CT-guided RFA. The transvenous RFA catheter is much easier to insert into the left adrenal vein than into the right, suggesting that the two RFA methods have complementary roles. Furthermore, it may be possible to perform AVS diagnosis and RFA treatment in a single procedure.

ANALYSIS OF RISK FACTORS OF BILE DUCT DAMAGE: THE CONCEPT OF SAFE LAPAROSCOPIC CHOLECYSTECTOMY

The article provides a literature review from the point of view of the concept of safe laparoscopic cholecystectomy and the causes of intraoperative damage to the bile ducts.The main provisions of the concept of safe cholecystectomy include: a clear understanding of the anatomy of the biliary tract; timely use of intraoperative visualization methods; compliance with the concept of safety before dividing the cystic duct and artery in each case; awareness of the importance of time-out; obtaining a second opinion in di ffi cult cases; the importance of proper documentation. It has been proven that the greatest number of complications in laparoscopic cholecystectomy occur during the intraoperative phase, and the most common reason is «problematic visualization».The goal of promoting the «safe cholecystectomy concept» is to reduce the rate of biliary tract injury and is a worldwide initiative aimed at improving the safety of the laparoscopic method.

Specimen mammography for intraoperative margin assessment in breast conserving surgery: a meta-analysis

In breast conserving surgery (BCS), specimen mammography is one of the most widely used intraoperative methods of assessing margin status. We performed a meta-analysis to evaluate the diagnostic accuracy of specimen mammography. Literature databases including PubMed, Cochrane Library, Web of Science, and EMBASE were searched prior to Jun 2022. A total of 1967 patients were included from 20 studies. A pooled analysis, heterogeneity testing, threshold effect testing, publication bias analysis, and subgroup analyses were performed from extracted data. The pooled weighted values were a sensitivity of 0.55 (95% confidence interval [CI], 0.47–0.63), a specificity of 0.85 (95% CI, 0.78–0.90), a diagnostic odds ratio of 7 (95% CI, 4–12), and a pooled positive likelihood ratio of 3.7 (95% CI 2.6–5.5). The area under the receiver operator characteristic curve was 0.75 (95% CI 0.71–0.78). In the subgroup analysis, the pooled specificity in the positive margin defined as tumor at margin subgroup was lower than the other positive margin definition subgroup (0.82 [95% CI: 0.71, 0.92] vs. 0.87 [95% CI: 0.80, 0.94], p = 0.01). Our findings indicated that specimen mammography was an accurate intraoperative imaging technique for margin assessment in BCS.

Intraoperative methods for assessing blood loss: A review

Massive blood loss that develops during surgery is a common cause of life-threatening conditions and deaths in patients of any age.&#x0D; This study aimed to analyze domestic and foreign publications that present methods for determining the volume of intraoperative blood loss.&#x0D; The literature sources were searched in PubMed, Scopus, Web of Science, MEDLINE, eLibrary, and Russian Science Citation Index databases. The search was conducted in Russian and English using the following keywords: intraoperative blood loss, severity of blood loss, methods for assessing blood loss, direct methods, and indirect methods. The literature review included five articles from PubMed, nine from Scopus, six from Web of Science, two from MEDLINE, six from eLibrary, and four from Russian Science Citation Index.&#x0D; Massive blood loss is understood as a one-time loss according to some authors of 30% and according to others of 50% of the volume of the circulating blood or blood loss equal in volume to 23 mL/kg/min. Risk factors for the development of intraoperative complications such as massive blood loss are, in addition to surgical interventions, the features of surgical intervention, i.e., size of the incision, surgical duration, and anesthesia, which can increase blood loss. The intensity and degree of blood loss are very important in determining the indications for transfusion of blood components, replenishing the volume of circulating blood, and determining indications for intraoperative hemostasis, both medical and surgical. In neonates and young children, the risk of dangerous intraoperative blood loss is associated with anatomical and physiological features, i.e., a small volume of circulating blood and insufficiently mature compensatory mechanisms. In older children, a high risk of massive blood loss is associated with comorbidities, features of hemostasis, and use of drugs that slow down the blood coagulation process.&#x0D; To date, several methods are available for assessing intraoperative blood loss, but only a few are used in routine clinical practice. Each method has advantages and disadvantages. One of the main disadvantages is the complexity of the mechanisms for assessing blood loss, for example, weighing surgical materials or the patient before and after surgery, determining hemoglobin in the liquid after soaking the used surgical materials, and calculating indices using formulas. Most often, the assessment of blood loss is conducted according to the clinical picture (pallor of the skin and mucous membranes, weak pulse, lowering blood pressure, etc.).&#x0D; The results of the literature analysis showed insufficient research on determining the volume of intraoperative blood loss in pediatric practice, as evidenced by the small number of published scientific papers and the complete absence of randomized trials. Thus, further study of this problem is necessary.

Comparison of Posterior Pedicle Screw Fixation and Lateral Fixation in the Extreme Lateral Interbody Fusion in Lumbar Degenerative Disease Patients with Osteopenia or Osteoporosis.

Nowadays, with the increasing proportion of osteoporosis in patients with lumbar degenerative diseases, doctors are facing the choice of intraoperative internal fixation methods. The purpose of this study was to compare and assess the clinical results of posterior bilateral pedicle screw fixation and lateral fixation in the extreme lateral interbody fusion (XLIF) in patients with osteopenia or osteoporosis. The retrospective review was performed on 67 degenerative lumbar diseases patients with osteopenia or osteoporosis who underwent XLIF in our hospital from January 2018 to July 2021. Patients in this study were classified into lateral screw (LS) group, lateral self-locking plate (LP) group, and bilateral pedicle screw (BPS) group. The functional evaluation factors containing Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) of leg pain, and VAS of low back pain, radiological factors such as disc height (DH), lumbar lordotic (LL) angle, segmental lordotic (SL) angle, cage subsidence degree and interbody fusion degree were compared. Primary outcomes: no differences were observed with regards to the incidence of complications among LS, LP and BS group (P < 0.05). The JOA and leg pain VAS were significantly improved after operation (P < 0.05) and all groups demonstrated similar improvements in the leg pain VAS and JOA score (P > 0.05). When comparing VAS of leg pain and JOA scores, no differences were identified among LS, LP and BPS groups (P > 0.05). There are four thigh sensory complaint, one hip flexor weakness and one thigh pain occurred and no death was observed. There were significantly better DH, LL angle, SL angle, cage subsidence degree and interbody fusion degree in the BPS group than in LS and LP groups 1 year after surgery (P < 0.05). The DH loss ratio, LL angle loss ratio, SL angle loss ratio in the BPS group was significantly lower than in the LP and LS groups (P < 0.05). The 12-month SL angle improvement rate in the BPS group was significantly higher than in the LP and LS groups (20.20± 14.69, 0.73 ± 4.68, 6.20 ± 12.31, P < 0.05). the BPS patients had significantly worse intraoperative blood loss and operation time than LS and LP patients (P < 0.05). In lumbar diseases patients with osteopenia or osteoporosis, the bilateral pedicle screw fixation has better orthopedic effect than lateral internal fixation, and can better maintain the stability of the spine in the long-term follow-up, which is a better choice in XLIF surgery.

Recruitment manoeuvres during mechanical ventilation with sequential high-flow nasal oxygen after extubation to prevent postoperative pulmonary complications in patients undergone thoracic surgery: a protocol, prospective randomised controlled trial

IntroductionThe incidence of postoperative pulmonary complications (PPCs) following thoracic surgery is high, which increases the mortality rate, prolongs the length of hospital stay and increases medical costs. Some studies have...

3D localization based on anatomical LANDmarks in the treatment of pulmonary nodules.

BackgroundVarious methods exist for locating lung nodules, each with its own advantages and disadvantages. Aiming to find a more accurate, safe, effective, economical and practical method for locating lung nodules, this study evaluated the safety and feasibility of a precise three-dimensional (3D) method for positioning small pulmonary nodules based on anatomical landmarks.MethodsFrom June 2019 to December 2021, 120 patients with 131 pulmonary nodules who underwent video-assisted thoracoscopic surgery at the University of Hong Kong-Shenzhen Hospital were included in the study. Surgical data such as the positioning time, accuracy rate, pathological result, localization-related complication rate and length of postoperative hospital stay were retrospectively reviewed and analyzed. During surgery, pulmonary nodules were accurately located by the 3D positioning method based on anatomical landmarks and then removed to determine the pathology.ResultsA total of 120 patients, including 35 males and 85 females, were included, and the median age was 53 years [interquartile range (IQR), 41–63 years]. No mortality or major morbidity occurred within 30 days. The median localization time was 11 minutes (IQR, 8–14 minutes). The accuracy of localization was 98.5%. The median diameter of the pulmonary nodules was 8 mm (IQR, 7–13 mm), and the median distance from the visceral pleura was 6 mm (IQR, 2–10 mm). No location-related complications occurred. The median length of postoperative hospital stay was 5 days (IQR, 3–7 days).ConclusionsThe proposed positioning method is accurate, safe and feasible for selected patients with pulmonary nodules. Compared with other preoperative and intraoperative positioning methods, it can significantly reduce localization-related complications.

Intraoperative tissue classification methods in orthopedic and neurological surgeries: A systematic review.

Accurate tissue differentiation during orthopedic and neurological surgeries is critical, given that such surgeries involve operations on or in the vicinity of vital neurovascular structures and erroneous surgical maneuvers can lead to surgical complications. By now, the number of emerging technologies tackling the problem of intraoperative tissue classification methods is increasing. Therefore, this systematic review paper intends to give a general overview of existing technologies. The review was done based on the PRISMA principle and two databases: PubMed and IEEE Xplore. The screening process resulted in 60 full-text papers. The general characteristics of the methodology from extracted papers included data processing pipeline, machine learning methods if applicable, types of tissues that can be identified with them, phantom used to conduct the experiment, and evaluation results. This paper can be useful in identifying the problems in the current status of the state-of-the-art intraoperative tissue classification methods and designing new enhanced techniques.

Utility of Scrape Cytology in Management of Ovarian Neoplasms: a Cross-sectional Study in a Tertiary Care Hospital of Eastern India.

Ovarian tumors are one of the most common gynecological neoplasms worldwide affecting women of all ages. As preoperative diagnosis is often inaccurate, intraoperative diagnostic modalities play indispensable role in management of ovarian tumors to avoid unnecessary extensive surgery. Although reliable, frozen section is highly expensive for resource-poor developing countries. Intraoperative cytological methods can help to overcome these limitations. The aim of this study was to evaluate the accuracy of scrape cytology in diagnosis of ovarian tumors. The freshly removed specimens of ovarian tumors sent without any fixative during the study period were included in this observational prospective cross-sectional study. Scraping was done from the most representative area of the cut surface of the tumor. Cytological smears were stained by hematoxylin-eosin method. All the cytological smears and corresponding histological sections were evaluated separately. Cytological interpretation was then compared with histological diagnosis to assess the diagnostic accuracy of scrape cytology. On histology, 66 cases were diagnosed as benign (60%), 5 cases as borderline (4.55%), and 39 as malignant (35.45%). Of these, 64 cases (58%) were of epithelial origin, 25 cases (22.7%) were of germ cell origin and 6 (5.45%) cases were categorized as sex cord-stromal tumor. Accuracy of scrape cytology in diagnosis of benign, borderline, and malignant ovarian tumors was found to be 95.45%, 40%, and 89.74%, respectively. Overall accuracy rate was 90.91%. Scrape cytology is a rapid, inexpensive yet effective tool to diagnose benign and malignant ovarian tumors with high diagnostic accuracy.

Objective evaluation of intraoperative prevention methods for seroma formation after axillary lymphatic dissection

Axillary dissection leads to the formation of a cavity in which serous fluid accumulates after surgery and causes seroma formation. The high frequency of this complication causes the need for preventive measures. Effective use of this preventive measures will reduce the economic burden on the medical institution, accelerate the rehabilitation of patients and improve their quality of life. This article presents an assessment of the effectiveness using of intraoperative methods for seroma formation prevention, in order to determine the most optimal method.

Commentary: Practicing the philosophy of continuous improvement with virtual-assisted lung mapping 2.0

Lung cancer screening programs have led to an increase in detection of small, semisolid or ground glass nodules concerning for malignancy.1,2 Without the ability to palpate these nodules, thoracic surgeons require precise intraoperative localization methods to perform sublobar resections with clear oncologic margins. One such method is virtual-assisted lung mapping (VAL-MAP). Now routine in Japan, VAL-MAP uses preoperative bronchoscopic placement of multiple dye marks on the lung surface to localize the nodule and guide the direction of the staple line to obtain adequate margins.

Histological features of scar tissue formation in different methods of postoperative wound closure

Scar tissue formation is a natural reaction to a violation of the integrity of body tissues, including after any surgical procedure. The main role in wound reparative histogenesis occurs due to the growth of connective tissue, the cells of which begin to healing processes belongs to the connective tissue. A big role in wound healing processes belongs to the connective tissue, which cells have an extremely high reactivity, grow, from both edges of the wound, towards each other and fasten the edges of the wound with their fibers, which in turn become stronger (they are sclerosed) and form a dense scar. Factors such as heredity, the state of the immune system, the patient's age, the presence of concomitant diseases, and many others have a great influence on the healing of the postoperative wound and the formation of scar tissue. Also, intraoperative methods of influence on wound healing such as a method of wound closure, drainage, hemostasis, debridement, influence on wound infection, etc., are undoubtedly very important. An experimental study was conducted to study and compare the histological changes of scar tissue in some options for closing the postoperative wound at the early postoperative stage. 60 animals were operated on, that were divided into 5 groups: one control and 4 experimental. They compared the methods of closing surgical wounds using the methods of suturing the wound with knotted sutures, intradermal suture, gluing the edges of the wound and using the method of electrowelding of tissues. The results of the histological examination showed equal effectiveness of the compared methods of closing the postoperative wound, with a tendency for faster development of the connective tissue of the dermis in the group in which electric welding was used. Keywords: skin, scars, postoperative stage, morphological and morphometric methods, regeneration.

OF RECONSTRUCTIVE SURGERY IN PATIENTS WITH COLOSTOMY

Abstract. Literature data on the results of reconstructive surgery in patients with previously imposed colostomy were analyzed. Colostomy application varies from 7 to 63 %. Failure of the seams of the intestinal anastomoses remains a topical issue of abdominal surgery. The incidence of such complications, according to various authors, reaches 3.8–14.6 % — in operations on the colon. The issue of restoring the integrity of the large intestine is quite relevant for colorectal surgery, colostomy varies from 7 to 63 %. Despite the improvement of existing and development of new methods of reconstructive surgery, the active use of intraoperative and postoperative diagnostic methods, it is not possible to completely avoid complications. The incidence of failure of the sutures of colonic anastomoses reaches 3.8–14.6 %. Further study and development of methods of reconstructive surgery after colostomy is needed to minimize the number of postoperative complications and improve the treatment outcomes of patients with colorectal pathology.

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series.

BackgroundAnastomosis management is the main challenge of airway resection and reconstruction, and postoperative anastomotic complications, including ischemia, stenosis, dehiscence, and separation may lead to severe outcomes and a poor prognosis. The anastomotic buttress is vital in airway reconstruction, but the selection of surgical buttress and reinforcement remains controversial. We aimed to demonstrate and evaluate the buttress options of anastomosis, including their preoperative characteristics, the intraoperative process, and the incidence of postoperative complications to help address the controversy regarding anastomosis management.MethodsThis retrospective study was conducted at a single institution. Patients who underwent airway reconstruction with anastomotic wrapping from Jan. 2019 to Sep. 2021 were enrolled in this study and preoperative characteristics and operational features were collected. All patients were carefully followed up by telephone and outpatient. Their postoperative complications and postoperative status after 6 months were recorded. The surgical procedures and clinical characteristics of the buttress options of anastomosis were assessed.ResultsA total of 62 patients undergoing either cervical tracheal, thoracic tracheal, carinal, or secondary carinal and main bronchus resection and reconstruction were evaluated. The anastomotic buttress used included mediastinal pleural flap (24/62, 38.7%), anterior cervical muscle (14/62, 22.6%), sternocleidomastoid (2/62, 3.2%), thymus flap (12/62, 19.4%), intercostal muscle flap (2/62, 3.2%), biological patch (2/62, 3.2%), prepericardial fat (1/62, 1.6%), thyroid gland (1/62, 1.6%), pectoralis major flap (2/62, 3.2%), and omental flap (2/62, 3.2%). All procedures produced satisfactory results without short-term anastomotic complications. A follow-up for 6 months was conducted and all patients were alive postoperatively. Tracheomalacia stenosis postoperatively occurred in 3 patients and they were subsequently treated with an endotracheal stent. One patient had tumor recurrence 3 months after surgery and received adjuvant chemotherapy.ConclusionsVarious anastomotic wrapping materials are used in airway reconstruction. Different utilizations of buttress are selected according to the anatomic characteristics and the reconstruction method used. This study indicated that appropriate surgical buttresses for wrapping anastomoses are legitimate alternatives to reduce the risk of anastomotic complications.