title: Biodegradable airway stents in infants - Potential life-threatening pitfalls.
abstract: OBJECTIVE
  The solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept.
  
  
  METHODS
  Five SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old).
  
  
  RESULTS
  The breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing 'foreign body' from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen.
  
  
  CONCLUSIONS
  Polydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4-6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary. Electronic address: sztano.balazs@med.u-szeged.hu.
authors.forename: B
authors.initials: B
authors.lastname: Sztanó
authors.affiliation: Heim Pál Children's Hospital Anesthesiology and Intensive Care Department, Budapest, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Kiss
authors.affiliation: Heim Pál Children's Hospital Anesthesiology and Intensive Care Department, Budapest, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Márai
authors.affiliation: Department of Pediatrics and Pediatric Health Care Center, University of Szeged, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Rácz
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, Hungary.
authors.forename: I
authors.initials: I
authors.lastname: Szegesdi
authors.affiliation: Department of Pediatrics and Pediatric Health Care Center, University of Szeged, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Rácz
authors.affiliation: Heim Pál Children's Hospital ENT Department, Budapest, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Katona
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Rovó
mesh_terms: D020341:Absorbable Implants / Q000009:adverse effects*; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery; D055091:Bronchomalacia / Q000628:therapy; D001999:Bronchoscopy; D005260:Female; D005547:Foreign Bodies / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016687:Polydioxanone / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects*; D014132:Trachea; D055090:Tracheomalacia / Q000628:therapy
chemical_list: D016687:Polydioxanone
keywords: Biodegradable material; Pediatric tracheal stenosis; Tracheal stenting; Tracheomalacia