Permanent Tracheostomy for Extended Laryngotracheal Resection.

Abstract

In this report, four patients who had undergone extended laryngotracheal resection were reviewed. Each case requiered low cervical or mediastinal tracheostomy becouse of wide resection of the trachea. The most critical complication of these cases is bleeding from the great vessels, and one of our cases died of rupture of the brachiocephalic artery. To avoid this complication, tension between the remining tracheal stump and the skin must be minimized. Accordingly, following points seemed to be important at surgical procedures. 1) In each case, skin flap for reconstruction of tracheostomy should be selected carefully. To decrease the tension on the flap, anterior thoracic skin defect left behind should be covered with a split-thickness skin graft. 2) Removal of the manubrium, the clavicular head and the first and second costal cartilages allowes the thoracic skin flap to dip down into the mediastinum. 3) The great vessels must be protected from direct contact with the trachea by bulky tissues.