Single-stage laryngotracheal reconstruction using bioabsorbable miniplates. 2010

Robert C Sprecher
Department of Otolaryngology, Division of Pediatric Otolaryngology, Case Western Reserve University, Cleveland, Ohio, USA. robert.sprecher@uhhospitals.org

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.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007829 Laryngostenosis Developmental or acquired stricture or narrowing of the LARYNX. Symptoms of respiratory difficulty depend on the degree of laryngeal narrowing. Laryngeal Stenosis,Acquired Laryngeal Stenosis,Acquired Subglottic Stenosis,Congenital Subglottic Stenosis,Acquired Laryngeal Stenoses,Acquired Subglottic Stenoses,Congenital Subglottic Stenoses,Laryngeal Stenoses,Laryngeal Stenoses, Acquired,Laryngeal Stenosis, Acquired,Laryngostenoses,Stenoses, Acquired Laryngeal,Stenoses, Acquired Subglottic,Stenoses, Congenital Subglottic,Stenoses, Laryngeal,Stenosis, Acquired Laryngeal,Stenosis, Acquired Subglottic,Stenosis, Congenital Subglottic,Stenosis, Laryngeal,Subglottic Stenoses, Acquired,Subglottic Stenoses, Congenital,Subglottic Stenosis, Acquired,Subglottic Stenosis, Congenital
D007830 Larynx A tubular organ of VOICE production. It is located in the anterior neck, superior to the TRACHEA and inferior to the tongue and HYOID BONE. Anterior Commissure, Laryngeal,Anterior Commissure, Larynx,Laryngeal Anterior Commissure,Laryngeal Posterior Commissure,Posterior Commissure, Laryngeal,Posterior Commissure, Larynx,Anterior Commissures, Laryngeal,Anterior Commissures, Larynx,Commissure, Laryngeal Anterior,Commissure, Laryngeal Posterior,Commissure, Larynx Anterior,Commissure, Larynx Posterior,Commissures, Laryngeal Anterior,Commissures, Laryngeal Posterior,Commissures, Larynx Anterior,Commissures, Larynx Posterior,Laryngeal Anterior Commissures,Laryngeal Posterior Commissures,Larynx Anterior Commissure,Larynx Anterior Commissures,Larynx Posterior Commissure,Larynx Posterior Commissures,Posterior Commissures, Laryngeal,Posterior Commissures, Larynx
D008297 Male Males
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013517 Otorhinolaryngologic Surgical Procedures Surgery performed on the ear and its parts, the nose and nasal cavity, or the throat, including surgery of the adenoids, tonsils, pharynx, and trachea. Otorhinolaryngologic Surgical Procedure,Otorhinolaryngological Surgical Procedures,Procedure, Otorhinolaryngologic Surgical,Procedures, Otorhinolaryngologic Surgical,Surgical Procedure, Otorhinolaryngologic,Surgical Procedures, Otorhinolaryngologic,Otorhinolaryngological Surgical Procedure,Procedure, Otorhinolaryngological Surgical,Procedures, Otorhinolaryngological Surgical,Surgical Procedure, Otorhinolaryngological,Surgical Procedures, Otorhinolaryngological
D014132 Trachea The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. Tracheas
D019651 Plastic Surgery Procedures Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures. Cosmetic Reconstructive Surgical Procedures,Cosmetic Surgical Procedures,Esthetic Reconstructive Surgical Procedures,Esthetic Surgical Procedures,Plastic Surgical Procedures,Reconstructive Surgical Procedures,Reconstructive Surgical Procedures, Cosmetic,Cosmetic Reconstructive Surgery,Procedure, Reconstructive Surgical,Procedures, Reconstructive Surgical,Reconstructive Surgical Procedure,Reconstructive Surgical Procedures, Esthetic,Surgical Procedure, Reconstructive,Surgical Procedures, Reconstructive,Cosmetic Reconstructive Surgeries,Cosmetic Surgical Procedure,Esthetic Surgical Procedure,Plastic Surgery Procedure,Plastic Surgical Procedure,Procedure, Cosmetic Surgical,Procedure, Esthetic Surgical,Procedure, Plastic Surgery,Procedure, Plastic Surgical,Procedures, Cosmetic Surgical,Procedures, Esthetic Surgical,Procedures, Plastic Surgery,Procedures, Plastic Surgical,Reconstructive Surgeries, Cosmetic,Reconstructive Surgery, Cosmetic,Surgeries, Cosmetic Reconstructive,Surgery Procedure, Plastic,Surgery Procedures, Plastic,Surgery, Cosmetic Reconstructive,Surgical Procedure, Cosmetic,Surgical Procedure, Esthetic,Surgical Procedure, Plastic,Surgical Procedures, Cosmetic,Surgical Procedures, Esthetic,Surgical Procedures, Plastic

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