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section and intrapericardial release, allowed most resections to be accomplished without extreme measures. The first "extreme" technique noted above was not used as described, both because of its complexity and the likelihood of loss of carinal blood supply. However, the concept proves invaluable for the resection of carina and a long length of trachea. As described in Chapter 29, "Carinal Reconstruction," reimplantation of the left main bronchus into the bronchus intermedius permitted high elevation of the right main bronchus to a tracheal remnant.

The second technique, devolution of cervical trachea to effect safe intrathoracic primary anastomosis, was employed in a small number of patients who had extreme resections in very complex situations. In some of these patients, a splinted cutaneous trachea was constructed successfully, primary reanastomosis became possible at a later date in one patient, and reconstruction was not completed for various reasons in several other patients. This record makes it obvious why, in addition to the complexity of the technique and potential for damage to recurrent laryngeal nerves, the method was abandoned.

The key issue, however, is that extremely few lesions that should be resected can not be resected and reconstructed by the presently devised surgical techniques.

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