Abstract
Tracheal and bronchial reconstruction was performed in 13 patients after traumatic injury. They included 4 patients with tracheal injury due to blunt chest trauma, 4 with post-intubation tracheal stenosis and 5 with bronchial injury due to blunt chest trauma. The pathogenesis, clinical presentation, diagnosis, management and postoperative complications are discussed. From our experience it was difficult to diagnose disruption of main bronchi or intrathoracic trachea immediately after blunt chest trauma except in 2 case with complete disruption of the cervical or lower thoracic trachea, which was thought to be attributed to complications outside the tracheobronchial tree. The usual signs of tracheobronchial disruption were subcutaneous and mediastinal emphysema, dyspnea and hemoptysis. Thus it is quite important first to perform bronchofiberscopy in patients showing these signs in order to maintain the airway. A patient with complete disruption of the lower trachea just above the tracheal carina underwent emergency surgery and was intubated with a Robert-Shaw tube into the left main bronchus via the bronchofiberscope with success. Early surgical intervention is advantageous in the treatment of tracheobronchial disruption, however, delayed reconstructive surgery seems to be safe if there are no infectious lesions near the site of the injury. Tears of the mid and lower trachea are best approached through a right posterolateral thoracotomy. Diseases of the upper trachea are approached by cervico-mediastinal approach with partial resection of the clavicula, first and second ribs and sternum. Postoperative complications of tracheobronchial reconstruction are strongly influenced by the appearence of infection, which caused disruption and granulomatous formation on anastomotic site. We experienced 2 cases of such complications after tracheal reconstruction. Three of 5 patients with bronchial anastomosis showed transient re-expansion pulmonary edema for a few hours during the early postoperative period. This complication should be kept in mind in patients with long-term atelectasis.
