Tracheal reconstruction under tension: an experimental study in sheep.
OBJECTIVE
Invasion of the trachea by thyroid cancer is a difficult problem. Circumferential resection and end-to-end reconstruction is the treatment of choice. The objective of our study was to investigate the effect of tension on tracheal healing and stenosis formation, and to ascertain the maximum tolerable tension.


METHODS
Tracheal resections of 3, 6 and 9 cm with end-to-end anastomosis were performed on 25 sheep. The intraoperative force required for approximation of the tracheal stumps was measured. Luminal stenosis was determined with the aid of computerized planimetry 1, 2, 4, 8 and 24 weeks post-operatively.


RESULTS
A gradual increase of the stenosis rate occurred with increasing tension on the anastomosis. Acceptable results were achieved in the majority of cases without release techniques or tension suture.


CONCLUSIONS
Tracheal anastomosis under tension does not always lead to disruption or separation of the anastomosis. With the additional use of release manoeuvres and tension sutures, tracheal anastomosis under tension are possible without severe stenosis. The additional use of temporary stenting needs to be elucidated.
Behrend
M
M
Klinik für Viszeral- und Transplantationschirurgie, Carl-Neuberg-Str. 1, 30623 Hannover, Germany. Behrend.Mattias@MH-Hannover.de
Klempnauer
J
J
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D005260:Female; D023421:Models, Animal; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D012756:Sheep; D013514:Surgical Procedures, Operative / Q000379:methods*; D013536:Suture Techniques; D013718:Tensile Strength; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000517:prevention & control*; D014945:Wound Healing / Q000502:physiology