Healing of the Juvenile Trachea Growth and Tension

The question of whether anastomosis performed in the juvenile trachea will grow adequately has been answered positively. As an example, Maeda and Grillo experimentally demonstrated that tracheal anastomosis in puppies resulted in some narrowing at the anastomotic site in the adult, caused by infolding of adjacent rings and restriction of growth by cicatrization of the membranous wall (Figure 6-22).57 At the anastomotic site, the average growth was 82% of normal sagitally, and 75% coronally, values equivalent to

figure 6-20 Bronchoscopic observations in congenital stenosis. A, Complete cartilaginous "O" rings are easily identified visually. B, Very rarely, irregular cartilaginous walls such as in this case are seen in a stenotic segment. Resected at age 9. See also Figures 1 and 2 in the Tracheobronchial Endoscopic Atlas (Color Plate 11).

figure 6-20 Bronchoscopic observations in congenital stenosis. A, Complete cartilaginous "O" rings are easily identified visually. B, Very rarely, irregular cartilaginous walls such as in this case are seen in a stenotic segment. Resected at age 9. See also Figures 1 and 2 in the Tracheobronchial Endoscopic Atlas (Color Plate 11).

figure 6-21 A, Congenital H-type tracheoesophageal fistula, visualized bronchoscopically posteriorly. B, Esophageal opening of the same fistula, on the anterior wall. The dark area below is the esophageal lumen. (Courtesy of Dr. Hon Chi Suen.)

20% stenosis of the tracheal lumen. Tension on the anastomosis caused by resection of progressively longer segments of trachea led to greater anastomotic narrowing when performed in puppies rather than in adult animals.58 Puppies were more susceptible to tension than adult animals. Levels allowing safety from disruption were 1,000 g in puppies and 1,750 g in adult dogs. The range of permissible resection was about half that of the adult, about 25% of the entire length of the juvenile trachea. Within permissible tension limits, fully adequate airways resulted (Figure 6-23). The use of a few spaced sutures from tracheal rings proximal and distal to the anastomosis, to reduce tension on the suture line, lessened postoperative narrowing.59 This is effectively accomplished clinically by our present use of lateral traction sutures (see Chapter 24, "Tracheal Reconstruction: Anterior Approach and Extended Resection"). Other laboratory work has generally confirmed this postanastomotic tracheal growth, with variations probably being due to experimental design.60-62

As experience with tracheal resection and reconstruction in infants and children increased, clinical results confirmed these expectations of anastomotic growth.63-66 Couraud and Monnier and their colleagues observed growth following similar laryngotracheal procedures.67,68 This contrasted with a diminished tracheal diameter and the need for later revisions or resection in children treated endoluminally or by plastic procedures. Further evidence of lesser tolerance of anastomotic tension in the juvenile trachea has been adduced, confirming the desirability of confining resection in children to 25 to 30% of the tracheal length.69

Growth of tracheal cartilage appears to occur continuously on the convex or outer side of a ring, with resorption taking place on the concave surface, without identifiable growth centers.70 Personal serial bron-choscopic observations of unoperated congenital stenosis showed that the stenotic segment grew proportionally to the normal trachea. Manson and colleagues demonstrated growth radiologically.71 These observations led to the expectation that growth would occur after slide tracheoplasty. Macchiarini and colleagues observed growth in an experimental model approximating slide tracheoplasty for long congenital steno-sis.72 Such growth has now been clinically confirmed by Grillo and colleagues.73

Was this article helpful?

0 0
Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.

Get My Free Ebook


Post a comment