Surgical approaches to membranous tracheal wall lacerations

Background: Smaller postintubation tracheal tears are often misdiagnosed an d, when recognized, they are effectively managed in a conservative fashion. Large membranous lacerations, especially if associated with important mani festations, require immediate surgical repair. We report our experience ove r the past 7 years. Methods: From 1993 to 1999, 11 patients with a postintubation posterior tra cheal wall laceration were treated in our institution. One patient was male and 10 were female, with a mean age of 68 years. Ten patients underwent or otracheal intubation under general anesthesia for elective surgery, 4 of wh om were treated with a double-lumen selective tube. One patient underwent e mergency intubation because of anaphylactic shock. In 9 cases the tracheal tear was promptly repaired, by way of a thoracotomy in 4 and by way of a ce rvicotomy and longitudinal tracheotomy in 5. In 2 cases the tear was small and was consequently managed conservatively. Results: All surgical procedures proved effective in repairing the lacerati on, and there was no mortality or morbidity in the perioperative period. Ea rly and late endoscopic follow-up showed no signs of tracheobronchial steno sis. Conclusions: When repair of membranous tracheal laceration is required, the surgical approach should be through a thoracotomy if the tear involves the distal trachea, a main stem, or both, and through a cervicotomy when the l aceration is located in the proximal two thirds of the trachea. Performing a longitudinal tracheotomy to reach and suture the posterior tracheal wall is a reliable, quick, and safe procedure, and it avoids lateral and posteri or dissection of the trachea.