Single-stage laryngotracheal reconstruction using bioabsorbable miniplates.
OBJECTIVE
The goal is to review the efficacy and safety of bioabsorbable miniplates as an alternative to autologous grafts in single-stage laryngotracheal reconstruction for subglottic stenosis.


METHODS
: Case series.


METHODS
A standard approach to the laryngotracheal complex is performed. The cricoid cartilage and first two tracheal rings are incised vertically, including the tracheostoma if present. A poly-L-lactic-acid-polyglycolic-acid bioabsorbable miniplate was cut to an approximate 1- to 1.5-cm length and 3- to 4-mm width, and placed over the cricoid defect. This plate was sutured in place using 4-0 undyed nylon sutures, securing the plate at each end to the cricoid cartilage. Care was taken to place these sutures submucosally in the tracheal lumen. If there was concern for suprastomal collapse, additional plates were placed inferiorly. The patient was taken back to the intensive care unit with a penrose drain in place and left sedated and intubated for 1 week and then re-evaluated in the operating room.


RESULTS
The procedure has been performed on 10 patients. All patients had a well-healed and fully mucosalized anterior tracheal wall with no evidence of plate or suture exposure at the time of extubation. There were no postoperative complications directly attributable to the use of the absorbable plate. All patients were successfully decannulated at the time of discharge. Long-term follow-up ranges from 14 to 63 months. No patients have required revision laryngotracheal reconstruction or repeat tracheostomy.


CONCLUSIONS
This study demonstrates that the use of bioabsorbable plates in select patients is a safe and effective alternative to the use of autologous cartilage grafts for single-stage laryngotracheal reconstruction for anterior subglottic stenosis. Donor site morbidity is eliminated, and operative time is decreased.
Sprecher
Robert C
RC
Department of Otolaryngology, Division of Pediatric Otolaryngology, Case Western Reserve University, Cleveland, Ohio, USA. robert.sprecher@uhhospitals.org
D020341:Absorbable Implants; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000601:surgery*; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D014132:Trachea / Q000601:surgery*