title: Management of postintubation membranous tracheal rupture.
abstract: BACKGROUND
  Postintubation tracheobronchial laceration is a rare complication of general anesthesia. A renewed interest in this disorder induced us to review our experience on its treatment, focusing on the evolution of the surgical approach, and describing a technical variation of the transcervical approach.
  
  
  METHODS
  From January 1994 to December 2002 we treated 13 patients with diagnosis of postintubation tracheobronchial laceration. The treatment was nonsurgical in 3 patients (1-cm-long tear) and surgical in the other cases. Two lesions extending to the main bronchi were repaired through a right thoracotomy as well as four lesions limited to the trachea observed before January 2001. After this date we used the transcervical approach for entirely intratracheal lesions: in three cases we performed an anterior transverse tracheotomy and in one case a transverse and midline vertical incision (T tracheotomy).
  
  
  RESULTS
  Both conservative and surgical therapy were successful in all the cases. Two patients in the thoracotomy group had a transient right vocal cord palsy. No morbidity was observed with the cervical approach. Normal healing of the sutures was evidenced by an endoscopic follow-up 30 days later.
  
  
  CONCLUSIONS
  In our experience nonsurgical treatment is advisable in small (length < 2 cm) uncomplicated tears. Concerning surgery, thoracotomy is indicated in tracheal lacerations extending to the main bronchi, whereas the transcervical approach is preferred for intratracheal tears because of its efficacy in reaching and suturing the lesions extending to the carina and for its limited invasiveness.
authors.affiliation: Department of Thoracic Surgery, University of Parma, Parma, Italy. paolo.carbognani@unipr.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Carbognani
authors.forename: Antonio
authors.initials: A
authors.lastname: Bobbio
authors.forename: Leonardo
authors.initials: L
authors.lastname: Cattelani
authors.forename: Eveline
authors.initials: E
authors.lastname: Internullo
authors.forename: Domenico
authors.initials: D
authors.lastname: Caporale
authors.forename: Michele
authors.initials: M
authors.lastname: Rusca
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D001980:Bronchi / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture; D013908:Thoracotomy; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D014140:Tracheotomy / Q000379:methods; D016896:Treatment Outcome