EFFECT OF STENTING ON GRAFT VASCULARIZATION AFTER LARYNGOTRACHEOPLASTY

The management of pediatric airway stenosis has been an important topi c of debate over the last few decades as prolonged intubation has beco me more common in the neonate. Although many surgical options are avai lable, most would agree that use of expansion techniques (laryngotrach eoplasty) with cartilaginous grafting is the procedure of choice for t he severely stenotic airway. Controversy persists, however, regarding the role of stents. Advocates feel that stents serve to counteract sca r contracture and support the newly constructed airway. In contrast, r ecent studies suggest that stenting results in impaired wound healing and an increased complication rate. The present study addresses the ef fect of stenting on the vascularization of cartilaginous grafts in an animal model. Thirty-six New Zealand white rabbits were evaluated afte r laryngotracheoplasty with autogenous cartilage grafting. Half of the animals were stented with a 2-cm section of an endotracheal tube that was secured just below the glottis. Three rabbits from each group wer e then painlessly sacrificed on days 4, 6, 8, 10, 14, and 21. Gross an d histologic comparisons of the stented and nonstented specimens revea led similar wound healing. Measurements of graft vascularization were obtained with a computerized image measurement program, and a comparis on was made regarding the rate of vascularization. There was a statist ically significant increase in the rate of vascularization in the sten ted group (mean 73% versus 55% at day 10; p < .05). This analysis sugg ests that stenting does not inhibit early wound healing and specifical ly graft vascularization after laryngotracheoplasty.