In 1982, Kimura and colleagues described anterior patch tracheoplasty for treatment of congenital stenosis involving the entire trachea (see Chapter 33, "Repair of Congenital Tracheal Lesions").91 The technique followed the principle of Gebauer's wire reinforced dermal grafts for tracheal and bronchial stenosis.92 Stenosis too long to be treated by resection and anastomosis was incised vertically throughout its length and the tracheal diameter widened by fitting a long cartilaginous graft (Figure 6-24B). An endo-tracheal tube was left in place until the patch became firm. A later report augmented their experience.93 Idriss and colleagues modified the procedure by using pericardium, which required not only postoperative splinting with an endotracheal tube but suture suspension of the pliable pericardial patch to medi-astinal structures as well.94 Considerable difficulty was encountered, with granulation tissue formation, necessitating multiple postoperative bronchoscopies (mean 3.8), especially for grafts extending far distally (mean 16).95 Twenty-one patients underwent pericardial patch repair, with 2 operative deaths and 3 late deaths. Six needed later tracheostomy, 2 for airway stenting. Troubled by the lack of intrinsic sup-
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