Tracheal Surgery: An Innovative Safe Technique - Pediatric Surgery
Tracheal Surgery is one of the most difficult of all surgeries. The challenge lies in maintaining the ventilation of the lungs after opening the trachea. As the vascularity of the trachea comes from the lateral sides, the lateral approach usually results in tracheal stenosis due to compromised blood supply and hence, increased morbidity in the long run. Assessing the whole length of the trachea is also technically difficult due to the overlying important structures. This technique is developed to assess all these surgical deficiencies. The patient is a 54 year old lady who suffered post intubation posterior tracheal rupture after a major Orthopedic surgery at a peripheral hospital. She was then referred to our centre (CSSH) after developing massive surgical emphysema and respiratory distress immediately after shifting from the OR. CT Scan revealed a long linear tear of the posterior trachea from the level of the cricopharynx just up to the carina. Routine endotracheal intubation is done with a smaller tube. The trachea is approached from the anterior aspect via a cervically extended sternotomy. After dividing the thyroid in the midline, the innominate vein is skeletonized. The pericardium is opened to facilitate rapid Cardiopulmonary Bypass with Aortic and Right atrium cannulation in case of failed ventilation. The arch vessels especially the Brachiocephalic trunk traversing the trachea horizontally is skeletonized and looped along with the Innominate vein. Manipulations ...
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