Multidisciplinary approach to surgical treatment and rehabilitation of patients with defects of the anterior tracheal wall

Abstract

The objective was to improve the results of treatment of patients with persistent defects of the anterior tracheal wall and soft tissues of the neck.Methods and materials. 220 patients with tracheal cicatrical stenosis were treated, of which 120 patients had defects of the anterior tracheal wall of various sizes. In 70% of cases, PCT was postintubation/posttracheostomy. Men predominated – 89 (74.2 %), women – 31 (25.8 %). After a routine examination, including endoscopic examination, MSCT of the chest with the capture of the cervical region, and general clinical diagnostic methods, all patients underwent surgical treatment.Results. According to the nature of the elimination of the defect of the anterior tracheal wall, patients were divided into several groups. Both local plastic surgery and the elimination of the tracheal defect with the use of microsurgical techniques were used. Circular resection of the trachea with the elimination of the defect was performed in 5 cases. In 2 cases, in the presence of a large persistent defect of more than 6 cm in size, a composite pre-fabricated deltopectoral skin-fascial-cartilage flap was used.Conclusion. The choice of a method for eliminating a persistent open defect of the anterior tracheal wall is determined individually in each case, it depends on its size, the depth of the airway lumen, and the condition of the surrounding tissues. The use of displaced skin-fascial flaps on the vascular pedicle for closing the tracheal defect allows to restore the mucous membrane of the tracheal defect area without using the surrounding scar tissue and close the defect with a second flap without straining the edges of the wound.