RESURFACING OF A LARGE LARYNGEAL WOUND WITH MUCOSA GRAFTING - A COMBINED TECHNIQUE USING ENDOSCOPIC SUTURE AND LASER SOLDERING

Resurfacing of a large laryngeal wound has traditionally been accompli shed via an open approach-transplanting free mucosa either onto the wo und directly or upon a stent. This study proposes a new approach for w ound resurfacing that combines endoscopic suturing with a laser weldin g technique. By means of a carbon dioxide (CO2) laser, a large (20 x 2 5 mm) defect in laryngeal mucosa involving the glottic and subglottic area was created in five dogs. Two of the animals served as controls a nd received no further treatment. In the remaining three animals the w ound was resurfaced with buccal mucosal grafts fixed in place by stand ard suture placement and a technique of CO2 laser-assisted tissue sold ering. The accessible edges of the graft were soldered endoscopically with human albumin-based tissue adhesive ''activated'' by low power (0 .8 to 1.0 W) of a CO2 laser. All animals were examined endoscopically 1 week after surgery and sacrificed painlessly 4 weeks after surgery. The treated animals showed a viable mucosal graft with improved wound healing and voice function compared to that of the control animals. Th is new approach combines suture fixation of the inferior aspect of the mucosal graft, an area not well exposed endoscopically, and endoscopi c laser soldering techniques for the repair of large laryngeal wounds.