title: Hyperbaric oxygen therapy for the treatment of anastomotic complications after tracheal resection and reconstruction.
abstract: OBJECTIVE
  Failure of anastomotic healing is a rare but serious complication of laryngotracheal resection. Treatment options include reoperation, tracheostomy, or T-tube placement. Hyperbaric oxygen therapy (HBOT) is the delivery of 100% O2 at pressures greater than 1 atm, and has been shown to enhance wound healing after tracheal resection in animal models. To date, there have been no reports describing its usefulness in humans after tracheal resection.
  
  
  METHODS
  Five consecutive patients with varying degrees of failed anastomotic healing, from necrotic cartilage to partial separation identified by bronchoscopy were treated with HBOT. HBOT was administered for 90 minutes via a hyperbaric chamber pressurized to 2 atm with 100% oxygen. Patients were treated with daily or twice daily HBOT. Four of 5 patients had buttressing of the anastomosis by strap muscle at the initial surgery.
  
  
  RESULTS
  All patients had evidence of anastomotic healing on bronchoscopy. None of the patients in this series required tracheostomy, T-tube, or reoperation after initiation of HBOT. On average it took 9.6 days for healing to occur (5-14 days). The size of the anastomotic defect ranged between 3 and 13 mm. One patient required bilateral tympanostomy tubes for inner ear discomfort and experienced blurry vision as complications of HBOT. One patient developed tracheal stenosis from granulation tissue that required bronchoscopic debridement.
  
  
  CONCLUSIONS
  In select patients with anastomotic complications after tracheal resection, HBOT may aid in healing and avoid tracheostomy. Future investigations are necessary to further define the benefits of HBOT in the management of airway anastomotic complications.
authors.affiliation: General Thoracic Surgical Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Cameron
authors.initials: C
authors.lastname: Stock
authors.affiliation: General Thoracic Surgical Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Natalie
authors.initials: N
authors.lastname: Gukasyan
authors.affiliation: General Thoracic Surgical Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Ashok
authors.initials: A
authors.lastname: Muniappan
authors.affiliation: General Thoracic Surgical Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Cameron
authors.initials: C
authors.lastname: Wright
authors.affiliation: General Thoracic Surgical Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: dmathisen@partners.org.
authors.forename: Douglas
authors.initials: D
authors.lastname: Mathisen
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014140:Tracheotomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult