MANAGEMENT OF MAJOR TRACHEOBRONCHIAL INJURIES - A 28-YEAR EXPERIENCE

Background. Tracheobronchial injuries are rare but potentially life th reatening. Their successful diagnosis and treatment often require a hi gh level of suspicion and surgical repairs unique to the given injury. Methods. We reviewed our experience with 32 patients with tracheobron chial injuries treated over the past 28 years. Results. Forty-one perc ent (13/32) of the injuries were due to blunt trauma and 59% (19/32), to penetrating trauma. Most penetrating injuries were located in the c ervical trachea (74%), whereas blunt injuries were more commonly locat ed close to the carina (62%). Fifty-nine percent of the patients requi red urgent measures to secure the airway. Penetrating injuries were us ually diagnosed by clinical findings or at surgical exploration. The d iagnosis of blunt injuries was more difficult and required a high inde x of suspicion and the liberal use of bronchoscopy. The majority of th e injuries were repaired primarily using techniques specific to the in jury, and most patients returned to their normal activity soon after d ischarge. Conclusions. A high level of suspicion and the liberal use o f bronchoscopy are important in the diagnosis of tracheobronchial inju ry. A tailored surgical approach is often necessary for definitive rep air. (C) 1998 by The Society of Thoracic Surgeons.