Complications of pediatric laryngotracheal reconstruction: Prevention strategies

A retrospective chart review was performed to quantify the postoperative co mplications and outcomes of 82 consecutive cases of laryngotracheal reconst ruction (LTR) and cricotracheal resection (CTR) performed at a pediatric te rtiary care hospital over the last 9 years. Six cases of respiratory syncyt ial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abs cess (PWA) were identified in a total of 12 patients. All of these infectio ns occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA w ere associated with significantly more unexpected days of intubation and ad mission to the intensive care unit, as well as higher rates of failure of L TR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, an d untreated gastroesophageal reflux disease (GERD) were also associated wit h restenosis. Trisomy 21 did not significantly influence the success rate o f pediatric LTR. Both RSV bronchiolitis and PWA ale potentially preventable complications of pediatric LTR and CTR. We propose strategies to prevent t hese infections. We also advocate the treatment of GERD during the healing phase of LTR.