Tracheal surgery:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2003
|
| Series: | Chest surgery clinics of North America
13,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XII S., S.176 - 404 Ill., graph. Darst. |
Staff View
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| 245 | 1 | 0 | |a Tracheal surgery |c Douglas J. Mathisen, guest ed. |
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| 650 | 4 | |a Trachea |x Surgery | |
| 650 | 4 | |a Trachea |x Surgery |x Complications | |
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Record in the Search Index
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| adam_text | CONTENTS
Preface xj
Douglas J. Mathisen
The History of Tracheal Surgery 175
Hermes C. Grillo
Contemporary tracheal surgery has developed primarily in the
last 40 years. Based largely on anatomic mobilization, present tech¬
niques permit resection of about half of the adult trachea with pri¬
mary reconstruction. Laryngotracheal and carinal reconstruction
and correction of long segment congenital stenosis are also now
dependable procedures.
Surgical Anatomy of the Trachea 191
Mark S. Allen
A clear understanding of tracheal anatomy is a fundamental building
block for surgical procedures. This article describes the surgical
anatomy of the trachea and emphasizes how these anatomic facts
affect surgical procedures performed on the trachea.
Tracheal Release Maneuvers 201
Richard F. Heitmiller
Tracheal release procedures are specialized surgical techniques that
permit low tension end to end primary reconstruction after tracheal
sleeve resection. Tracheal release maneuvers include dissection of
the pretracheal plane, cervical flexion, laryngeal release, and right
hilar release. Dissection of the pretracheal plane and cervical flexion
are the two most common techniques that are employed.
VOLUME 13 • NUMBER 2 • MAY 2003 v
Airway Stenting 211
Douglas E. Wood
A wide variety of airway pathologies may result in central airway
obstruction. Definitive surgical correction is preferred, but patients
can be palliated by numerous endoscopic strategies. Airway stent¬
ing provides reliable and durable palliation in 80% to 90% of pro¬
perly selected patients. The benefits and risks of airway stenting
must be considered in comparison with the other options for
airway palliation.
Postintubation Tracheal Stenosis 231
John C. Wain
Postintubation tracheal stenosis is a clinical problem caused by
regional ischemic necrosis of the airway. The incidence of post¬
intubation tracheal stenosis has decreased with recognition of its
etiology and modifications in the design and management endo
tracheal and tracheostomy tubes; however, it remains the most
common indication for tracheal resection and reconstruction.
Single stage resection and reconstruction by a competent tracheal
surgeon results in good or satisfactory results in 93.7% of patients,
with a failure rate of 3.9% and a mortality rate of 2.4%.
Primary Tracheal Tumors 247
Henning A. Gaissert
Squamous cell and adenoid cystic carcinoma comprise the malig¬
nant majority of primary tracheal tumors, with a smaller fraction
of benign or low grade malignant tumors. Tracheal resection offers
long term survival for patients with malignant tumors and is com¬
bined with postoperative radiation to reduce the risk of local recur¬
rence. The operative risk of tracheal or laryngotracheal resection is
low, whereas carinal resection remains a technical challenge.
Clinical series demonstrate resection rates of more than 60%, but a
wide disparity in treatment and the dismal outcome in epidemio
logic surveys suggest that most patients are not referred for tra¬
cheal resection.
Idiopathic Laryngotracheal Stenosis 257
Simon K. Ashiku and Douglas J. Mathisen
Idiopathic laryngotracheal stenosis is a rare inflammatory disease
that results in a cicatricial stenosis of the cricoid and upper trachea.
It occurs almost exclusively in women and its cause is unknown.
Single staged laryngotracheal resection is successful in more than
90% of patients and is the most effective treatment when per¬
formed by experienced hands. Long term follow up shows stable
airway and improvement in voice quality. Palliative procedures
vi CONTENTS ;
such as repeated airway dilations should be reserved for poor
surgical candidates.
Tracheoesophageal Fistula 271
Michael F. Reed and Douglas J. Mathisen
Acquired tracheoesophageal fistula can occur from malignant and
nonmalignant etiologies. A nonmalignant tracheoesophageal fistula
is usually a complication of endotracheal or tracheostomy cuffs,
and initial conservative management allows ventilator weaning
before a single stage repair. The esophageal defect is closed prima¬
rily and covered with a strap muscle flap while the trachea is either
repaired primarily or resected and reconstructed. Malignant tra¬
cheoesophageal fistula is a serious complication of esophageal or
lung cancer that carries a dismal prognosis. It is best managed by
palliative techniques such as esophageal bypass or stenting.
Tracheal Trauma 291
Joseph B. Shrager
Traumatic injuries to the trachea are uncommon, but they are often
life threatening. Prompt recognition and appropriate immediate
care can convert a life threatening situation into one that can be
successfully managed in a high percentage of cases by using now
fairly standard surgical techniques. This article addresses the etio¬
logy of these injuries, their presentation, and their management,
including preferred methods of immediate airway control, preope
rative evaluation, and intraoperative techniques. The author also
discusses special situations such as combined tracheoesophageal
injuries and thermal injuries.
Pediatric Tracheal Surgery 305
Cameron D. Wright
Pediatric tracheal surgery is uncommon, and few centers have
enough experience to make meaningful conclusions about treat¬
ment. Short segment congenital tracheal stenosis is treated by tra¬
cheal resection, whereas long segment stenosis is treated by either
augmentation tracheoplasty or slide tracheoplasty (the author s
preferred approach). Tracheomalacia is treated most commonly by
aortopexy. Postintubation tracheal stenosis is usually treated by
tracheal (or laryngotracheal) resection.
Carinal Resection and Reconstruction 315
John D. Mitchell
Carinal resection and reconstruction remains a relatively daunting
operation for most thoracic surgeons despite recent reports
CONTENTS vii
describing improved results for these procedures. This article
details the surgical approach to carinal resection, including the
anastomotic techniques and the modes of carinal reconstruction,
which have remained largely unchanged since they were initially
outlined by Dr. Hermes Grillo two decades ago. Improvements in
operative mortality to less than 10% in contemporary studies can
be attributed to better patient selection and advances in intraope
rative and postoperative care. In patients with bronchogenic carci¬
noma, long term survival rates in excess of 40% can be anticipated
in the absence of mediastinal nodal involvement.
Tracheoinnominate Fistula: Diagnosis and Management 331
James S. Allan and Cameron D. Wright
Tracheoinnominate fistula is a rare, life threatening complication
that can occur following rracheostomy or other tracheal proce¬
dures. Physicians who care for patients at risk for tracheoinnomi¬
nate fistula need to maintain a high index of suspicion to allow the
prompt recognition of this serious complication. This article pre¬
sents strategies for emergency intervention and operative repair.
The Burned Trachea 343
Subroto Paul and Raphael Bueno
Inhalation injury causing tracheal damage is an unusual but serious
complication of burn injuries. Appropriate acute management
requires a high index of suspicion and careful treatment in a moni¬
tored setting. Effective management of chronic complications of
tracheal burns is labor intensive and might last for many years.
Tracheomalacia 349
Cameron D. Wright
Tracheomalacia is a rare tracheal problem that leads to collapse of
the airway and expiratory flow obstruction. Expiratory CT scans
are the diagnostic test of choice in adults. Chronic obstructive pul¬
monary disease is the most common cause of adult tracheomalacia.
Plication of the membranous wall to polypropylene mesh to recreate
the normal airway shape (membranous wall tracheoplasty) is an
effective treatment in adults.
Surgical Management of Thyroid Carcinoma Invading
the Trachea 359
Zane T. Hammoud and Douglas J. Mathisen
Airway invasion by thyroid carcinoma is an uncommon but ;
important clinical problem. The surgical management of airway !
invasion is somewhat controversial, with some studies suggesting I
that conservative shave procedures might be adequate; however, j
1
viii CONTENTS
the standardization and safety of techniques of airway resection
and reconstruction have made en bloc surgery a reasonable approach
for the management of such carcinomas. Tracheal resection and
reconstruction for thyroid carcinomas with airway invasion might
provide long lasting palliation and might even be curative in a sig¬
nificant number of patients suffering from this disease.
Management of Persistent Tracheal Stoma 369
K. Robert Shen and Douglas J. Mathisen
A rare late complication of tracheostomy is persistence of the
stoma after removal of the tracheostomy tube. This article reviews
the indications for surgical repair and outlines two alternative
approaches to surgical management of this problem.
Reoperative Tracheal Surgery 375
Dean M. Donahue
In an initial attempt at tracheal resection and reconstruction for
postintubation tracheal stenosis, a successful outcome can be ex¬
pected in more than 95% of patients. Failure of the tracheal anas¬
tomosis with restenosis might occur, and it requires immediate
recognition. Management options include placement of a tra¬
cheostomy or T tube or reoperation and attempted repair. Little
has been written about reoperative tracheal resection and recons¬
truction following a failed initial attempt at repair. Dr. Grillo has
demonstrated that reoperative resection of the failed anastomosis
and reconstruction of the trachea can be successful in most cases.
Management of Complications of Tracheal Surgery 385
Michael Lanuti and Douglas J. Mathisen
Success in tracheal surgery requires sound judgment, careful
patient selection, attention to technical detail, and recognition of
indications for surgery. Postoperative complications can be mini¬
mized if these principles are followed. The best chance for success
for tracheal reconstruction is with the first operation. Optimal con¬
ditions must be present to ensure the greatest chance for uncom¬
plicated success.
Index 399
CONTENTS ix
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| spelling | Tracheal surgery Douglas J. Mathisen, guest ed. Philadelphia [u.a.] Saunders 2003 XII S., S.176 - 404 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Chest surgery clinics of North America 13,2 Trachea Surgery Trachea Surgery Complications Chirurgie (DE-588)4009987-8 gnd rswk-swf Luftröhre (DE-588)4134946-5 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Luftröhre (DE-588)4134946-5 s Chirurgie (DE-588)4009987-8 s DE-604 Mathisen, Douglas J. Sonstige oth Chest surgery clinics of North America 13,2 (DE-604)BV005455558 13,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=010349528&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Tracheal surgery |
| title_auth | Tracheal surgery |
| title_exact_search | Tracheal surgery |
| title_full | Tracheal surgery Douglas J. Mathisen, guest ed. |
| title_fullStr | Tracheal surgery Douglas J. Mathisen, guest ed. |
| title_full_unstemmed | Tracheal surgery Douglas J. Mathisen, guest ed. |
| title_short | Tracheal surgery |
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