A modified technique of laryngotracheal reconstruction without the need for prolonged postoperative stenting Konrad Hoetzenecker, MD, PhD, Thomas Schweiger,

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Presentation transcript:

A modified technique of laryngotracheal reconstruction without the need for prolonged postoperative stenting Konrad Hoetzenecker, MD, PhD, Thomas Schweiger, MD, Imme Roesner, MD, Matthias Leonhard, MD, Gabriel Marta, MD, Doris M. Denk-Linnert, MD, Berit Schneider-Stickler, MD, Wolfgang Bigenzahn, MD, Walter Klepetko, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 4, Pages 1008-1017 (October 2016) DOI: 10.1016/j.jtcvs.2016.01.061 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Photographs depict important surgical steps of the modified laryngotracheal reconstruction. A, After a complete anterior laryngeal split and resection of the cricoid arch, the side-to-side nature of the glottosubglottic stenosis can be seen. B, The cricoid plate is transected in the midline to facilitate an enlargement of the glottic diameter. C, Rib cartilage is harvested and trimmed with 2 flanges on both sides. D, The cartilage graft is inserted between the split parts of the cricoid plate and forms a stable reconstruction. E, The graft is covered by a dorsal mucosal flap with a running 5-0 polydioxanone suture. F, The anterior laryngeal split is closed, and a thyrotracheal anastomosis with the V-shaped distal trachea is performed. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1008-1017DOI: (10.1016/j.jtcvs.2016.01.061) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Preoperative (left) and postoperative (right) bronchoscopic findings (top), voice range tests (middle), and lung function tests (bottom) of patient 1. A significant enlarged airway diameter led to a profound improvement of lung function parameters. F/V, Flow/volume; TLC, total lung capacity; ITGV, intrathoracic gas volume; RV, residual volume. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1008-1017DOI: (10.1016/j.jtcvs.2016.01.061) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Diagram illustrates the main differences between the classical Couraud technique (A) and the modifications described in this case series (B). The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1008-1017DOI: (10.1016/j.jtcvs.2016.01.061) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Scheme of the modified technique of laryngotracheal reconstruction. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1008-1017DOI: (10.1016/j.jtcvs.2016.01.061) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 This video illustrates surgical steps of the modified laryngotracheal reconstruction technique. Video available at http://www.jtcvsonline.org/article/S0022-5223(16)30886-8/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1008-1017DOI: (10.1016/j.jtcvs.2016.01.061) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 2 Video shows preoperative extent of the stenosis and postoperative result after reconstruction. Video available at http://www.jtcvsonline.org/article/S0022-5223(16)30886-8/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1008-1017DOI: (10.1016/j.jtcvs.2016.01.061) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1008-1017DOI: (10.1016/j.jtcvs.2016.01.061) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions