Resuture may not be possible in the very rare occurrence of frank separation early after a tracheal anastomosis. Management may be attempted by a T tube or an endotracheal tube (if the patient requires ventilation) that spans the area of separation. If the innominate artery or aortic arch is adjacent, it seems judicious to wrap the dehisced airway and its splinting tube with the omentum, interposing it between airway and vessels.
Fortunately, the problem very rarely occurs and experience is therefore minimal. A patient who had massive irradiation for squamous cell carcinoma of the upper trachea prior to transfer to this hospital was found at resection to have an abscess adjacent to the necrosing tumor. The anastomosis following resection initially appeared satisfactory. Subsequent localized necrosis and leakage in the lateral wall of the trachea at the anastomosis was managed by débridement, omental wrapping, and a splinting T tube. The airway remained functional for 6 months until death, which occurred from multiple pulmonary metastases from a highly aggressive tumor.
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