Multidisciplinary approaches in the surgical treatment of cicatrical stenosis of the trachea

Abstract

Method: Circular resection of the trachea is a radical method of treatment of cicatricial stenosis. However, for extended, multifocal stenoses, severe comorbidities, and neurological deficits, multi-stage reconstructive surgery is recommended.

Material and Methods: from 2008 to 2020, 220 patients with tracheal sicatrical stenosis were treated. Stenoses of tracheolaryngeal zone (37%) and the upper third of the trachea (31%) prevailed. In 68% of cases stenosis was postintubation/posttracheostomy. Over time, methods of anesthesia, and options for operations have changed. If at the beginning of our study, cases of endoscopic treatment with coagulation, expansion of the tracheal lumen by buging and installation of internal stents of the Dumont type prevailed, then the number of circular tracheal resections increased, and after 2015, due to an increase in the number of patients with multifocal and extended stenoses, multi-stage reconstructive operations are more used.

Results: After the first stage of plastic surgery of the tracheal lumen on the T-shaped stand, the question of eliminating the open defect is raised. All patients were divided into 3 groups: I. skin-muscle-skin plastic surgery according to Bokstein in the clinic modification (n=82). II. Plastic surgery with displaced flaps, including implantation of an autorib cartilage graft (n=9). III. Plastic surgery using a pre-fabricated skin-fascial-cartilage flap on the vascular pedicle (n=2). Some patients are in the intermediate stages of treatment. As a result of improving the algorithm for diagnosis and treatment, we managed to reduce the frequency of postoperative complications to 13.4%, and the lethality rate was 0.9%.