[The risks of autogenous cartilage grafting in laryngotracheal reconstruction in adults].
BACKGROUND
Laryngotracheal reconstruction with autogenous rib cartilage graft has become a well established surgical method for the repair of subglottic and glottic laryngotracheal stenoses in infants and children. There are far fewer reports on the application of this method in adult patients. In particular, detailed observations of the healing behaviour of autogenous adult rib cartilage grafts are lacking.


METHODS
The course of disease in five adult female patients (age 25-47 years) who underwent one- or two-stage laryngotracheal reconstruction with rib cartilage grafts are reported.


RESULTS
Primary healing was observed in the youngest patient (25 years) only. In the other four patients the cartilage graft had to be partly removed 4-6 weeks postoperatively due to partial necrosis, followed by open wound treatment. As a result of these measures a sufficiently large laryngotracheal lumen could be achieved in all cases.


CONCLUSIONS
Partial ossification of the adult rib cartilage was considered the reason for the observed healing difficulties. Endoscopic follow-up showed that epithelialization of the free endolaryngeal surface of the cartilage graft, i.e. graft healing, takes at least 3 months. Therefore, close endoscopic follow-up during this period appears indispensable.
scoulon@t-online.de
H-J
HJ
Schultz-Coulon
T
T
Stange
A
A
Neumann
D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D004940:Esophageal Stenosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007829:Laryngostenosis / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome