Tracheoplasty technics for reconstruction after extensive resection

Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration. A critical review.

“…After resection of long lengths of the trachea tension on the suture line may be reduced by performing a Z-plasty (Narodick, Worman, and Pemberton, 1965;Worman, Starr, and Narodick, 1966), and this technique has been mentioned in connexion with post-tracheostomy stenosis by Deverall (1967) and Pearson et al (1968). Two hemispherical incisions are made through opposite halves of the circumference of the remaining tracheal wall, one above the other, and each bet\ een two cartilages.…”

“…Two hemispherical incisions are made through opposite halves of the circumference of the remaining tracheal wall, one above the other, and each bet\ een two cartilages. These incisions, which need not include the mucosa, result in window defects which are covered by a periosteal pedicle graft or a patch of synthetic material, such as knitted Dacron (Worman et al, 1966). The grafts epithelialize early, soon become rigid, and are not liable to infection, and in these respects are superior to synthetic materials such as Teflon.…”

“…The writers stated that the operation seemed simpler than resection and endto-end anastomosis. This type of reconstruction should not be confused with the Z-plasty (Narodick et al, 1965;Worman et al, 1966) previously described to relieve tension after resection and end-to-end anastomosis. Kennedy (1968) successfully treated an adherent, calcified stomal stenosis by incising it longitudinally and then inserting an oval-shaped free cartilage graft.…”

Tracheal stricture following tracheostomy

“…Flavell in 1959 described this technique, and a further successful result was published by Binet and Aboulker (1961). Tracheal tension at the suture line may be reduced by using the Z plasty technique described by Narodick, Worman, and Pemberton (1965) and Worman, Starr, and Narodick (1966). Recurrent laryngeal nerve damage has occurred in one patient (case 6).…”

Tracheal Replacements: Part 2

“…59 Dacron patches have also been used in combination with tracheal approximation by Z-plasty. 62 Silicone elastomer-reinforced Dacron prostheses developed granulations and stenosis from ingrowth of connective tissue. 63 A 5-cm Gore-Tex tube with reinforcing rings demonstrated integration into the connective tissue (in 5 to 7 weeks), but the details of the reported epithelization and long-term results were not described.…”