SURGICAL TREATMENT OF PERSISTENT DEFECTS OF THE ANTERIOR WALL OF THE TRACHEA IN CHILDREN

Abstract

Elimination of permanent defects of the anterior wall of the trachea is a crucial issue, as it is the subject of research and discussion of thoracic surgeons, plastic surgeons and otolaryngologists. The authors presented the results of the treatment of twelve patients with defects of the anterior wall of the cervical trachea, subglottic division of the larynx and soft tissues of the neck after laryngotracheotomy or tracheostomy. The article studies the main surgical interventions used in the treatment of this complex category of patients. It analyses the types of plastic trachea and their complications in detail. Special attention is paid to a differentiated approach in choosing a particular method of tracheal plasty. The reconstruction on a T-shaped endoprosthesis is the “gold standard” in the presence of neurological deficit and severe concomitant pathology in patients with multifocal and multilevel tracheal stenosis, when the implementation of circular tracheal resection is impossible. The choice of the method of plastic surgery or reconstruction of the trachea defect in children is determined in each specific case individually. In case, when the size of the tracheal defect is up to 20х28 mm, the skin-muscular plastic of the defect with local tissue replacement is recommended with a sufficient depth of the lumen of the trachea, which corresponds to the lumen below and above the defect, the single axis of the trachea and the distal larynx without displacement and deformity of the lumen.