An experimental model to investigate initial tracheal anastomosis strength

Schilt, Peter N.; McRae, Bryan R.; Akkuş, Ozan; Cordes, Susan R.; Halum, Stacey L.

doi:10.1002/lary.20908

Cited by 9 publications

(19 citation statements)

References 24 publications

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“…This was accomplished by using a previously validated model 18 to compare tracheal anastomoses with and without cartilaginous reinforcing sutures.…”

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confidence: 99%

The Effect of Cartilaginous Reinforcing Sutures on Initial Tracheal Anastomotic Strength

Schilt¹,

Musunuru²,

Kokoska³

et al. 2012

Otolaryngol.--head neck surg.

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“…This was accomplished by using a previously validated model 18 to compare tracheal anastomoses with and without cartilaginous reinforcing sutures.…”

mentioning

confidence: 99%

The Effect of Cartilaginous Reinforcing Sutures on Initial Tracheal Anastomotic Strength

Schilt¹,

Musunuru²,

Kokoska³

et al. 2012

Otolaryngol.--head neck surg.

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“…Polyglactin (Vicryl) and polydioxanone are commonly used suture materials for the different techniques of tracheal anastomosis. Primary anastomosis with interrupted 3/0 or 4/0 Vicryl sutures is the most preferred approach in tracheal stenosis [2,8,10]. After the resection, two traction sutures are usually placed on both sides of the proximal and distal trachea.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The effect of polyglycolic acid mesh application in tracheal anastomoses on pressure and tensile strength: an ex vivo experimental study

Kılıçgün¹,

Biçer²,

Kutluk³

et al. 2019

Curr Thorac Surg

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To cite this article: Kılıçgün A, Biçer YO, Kutluk AC, Seyhan S, Köybaşı Sanal S. The effect of polyglycolic acid mesh application in tracheal anastomoses on pressure and tensile strength: an ex vivo experimental study. Curr ABSTRACTBackground: This study aims to investigate the effect of polyglycolic acid (PGA) mesh application in tracheal anastomosis on the air-leakage and tension resistance. Materials and Methods:Tracheae were collected from freshly slaughtered healthy sheep weighing 25-30 kg (2-3 years old) that were acquired from the local slaughterhouse. Twenty-eight tracheae were transported to the laboratory within an hour of slaughter and then dissected to remove the esophagus before obtaining 20-cm long tracheae. All tracheae were transected at the midpoint. In Groups 1 and 2, the transected tracheae were anastomosed by using interrupted 3-0 Vicryl sutures. In Groups 3 and 4, after anastomosing the transected tracheae with interrupted 3-0 Vicryl, the sites of anastomosis were reinforced by using Polyglycolic acid mesh. Groups 1 and 3 were tested for tensile strength, while Groups 2 and 4 were tested for pressure resistance. Results:The median pressure was 49.00 ± 7.47 mmHg in the group anastomosed with only Vicryl, whereas it was measured as 70 ± 13.49 mmHg in the group on which the anastomoses were reinforced with PGA mesh. The median force needed to break anastomoses were 166.40 ± 24.28 Newton in the Vicryl-only group and 136.80 ± 34.93 newton in the PGA-reinforced group. The difference between the pressure resistance values of the Vicryl-only group and the PGA reinforced group was significant (p = 0.006). However, the difference with regard to the tensile strength was insignificant (p = 0.201). Conclusion:We found that the reinforcement of the anastomosis site with polyglycolic acid mesh significantly increases the pressure resistance but does not significantly affect tensile strength.

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“…Once the approximation of the two tracheal or laryngotracheal stumps is tested, the anastomosis should be performed by radially disposed, interrupted, extramucosal, absorbable stitches, as proposed by Grillo, making sure to obtain a full mucosal approximation, in order to avoid intervening granulations and/or stenosis (19). In the last decades, several materials have been proposed to guarantee a lower rate of anastomotic dehiscence (usually around 5% in the most representative and modern series), but a recent study did not find significant differences among them, with polyglactin (commercialized as "Vycril") the most widely used (20).…”

Section: Open Surgery Of Tumors Involving the Cervical Tracheamentioning

confidence: 99%

Surgical treatment of primary tracheal tumors in children and adolescents

Giannini¹,

Incandela²,

Bresciani³

et al. 2019

Pediatr Med

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Pediatric primary tracheal tumors (PTTs) are rare entities, with an estimated incidence of 0.2% among all neoplasms in children and adolescents. Benign lesions and malignancies are rather equally represented, with subglottic hemangioma, granular cell tumor, carcinoid tumor, and low-grade mucoepidermoid carcinoma being the most common histotypes. Guidelines on management and treatment of pediatric PTTs are not available, and only a few reviews, case reports, and single surgeon/institute experiences have been published. A literature search was carried out focusing on the surgical approaches utilized in the most recent publications to manage pediatric PTTs, thus including case reports, single institute experiences, and reviews on surgical techniques. Moreover, we divided the available intervention modalities based on an anatomical classification, distinguishing between laryngotracheal, cervical tracheal, lower tracheal, and carinal scenarios. Endoscopic treatment is still underused, even for benign lesions: this is mainly due to the difficulties that surgeons may experience during airway management, appropriate tumor visualization, and its safe removal with adequate prevention/management of intraoperative complications.Considering open surgery, simple tumorectomy via median thyrotomy is the treatment of choice whenever possible (mainly for benign tumors), whereas in case of wider excisions, laryngotracheal resection and reconstruction with cartilage graft, end-to-end anastomosis, or neo-carinal reconstruction represent the most widely used procedures. All these techniques are similar to what described in adults. Strict cooperation with an experienced team of pediatric anesthesiologists and intensivists is of paramount importance for the adequate management of PTTs in young children. We are far from establishing a common guideline for treatment of PTTs. Mini-invasive procedures should be encouraged and developed since the majority of pediatric histotypes are benign or low-grade cancers. Moreover, patients should be addressed to specialized pediatric centers in order to improve and refine the existing techniques, laying the groundwork for the proposal of new procedures.

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An experimental model to investigate initial tracheal anastomosis strength

Abstract: We introduce an inexpensive tool for measuring initial tracheal anastomosis stability with human cadavers, which demonstrated no difference in the tracheal pull-through strength of Vicryl and PDS.

Cited by 9 publications

References 24 publications

The Effect of Cartilaginous Reinforcing Sutures on Initial Tracheal Anastomotic Strength

The Effect of Cartilaginous Reinforcing Sutures on Initial Tracheal Anastomotic Strength

The effect of polyglycolic acid mesh application in tracheal anastomoses on pressure and tensile strength: an ex vivo experimental study

Surgical treatment of primary tracheal tumors in children and adolescents

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