Clinical experience with the silicone tracheal prosthesis.

The superiority of using the patient's own tissue for tracheal reconstruction is acknowledged. When this is impossible an alternate method is mandatory. From 1970 to 1988, 62 patients with benign and malignant tracheal stenosis had airway continuity established with a silicone tube. A straight graft was used in 48 patients. Twenty-eight had strictures, two tracheoesophageal fistulas and strictures, five primary malacia, and 13 malignant tumors. In 20 with noncancerous tracheal obstruction the airway was resected and a graft interposed. Distal suture line granulomas developed in six of these patients. Two had subglottic granulomas. One had graft dehiscence after dissolution of absorbable suture material. This graft was replaced with a silicone T tube. Four patients with end-to-end anastomosis of the graft to the trachea died in 6 to 12 months. Six others were lost to follow-up. In 15 of the 48 with benign disease the stent was placed within the lumen. Six in this group died. Thirteen of the 48 patients had a malignant tumor. In six the tube was used for palliation; none are alive. Seven underwent resection; five are living 1 to 8 years after the operation, two died of their disease in 1 1/2 to 2 years, and two of the five living are undergoing irradiation for recurrent cancer. Fourteen individuals with tracheocarinal malignancy received a bifurcated graft. All six patients with a palliative intraluminal stent died. Among eight individuals, four died of disease in 1 to 4 years. Four are alive, but two have suture line granulomas and two are undergoing irradiation for residual carcinoma. Mediastinal infection, mucus encrustations of the intraluminal prosthesis, and impedence of pulmonary secretions across long tubular segments have not been manifest. These silicone tubes are well tolerated and function satisfactorily as an airway.