Adjunctive measures for successful laryngotracheal reconstruction.

The field of reconstructive surgery of the laryngotracheal complex has been the object of considerable enthusiasm in recent years. New surgical techniques, better surgical tools, and improved diagnostic skills all have contributed to a more confident approach to severe laryngotracheal stenosis. Just as the surgeon's judgment is crucial for a successful primary laryngotracheal reconstruction, so are his or her skill and judgment vitally important in managing the various problems that frequently are found following reconstructive surgery of the larynx and trachea. These problems, although seemingly minor, may prevent successful decannulation if not managed appropriately. This paper discusses the various problems that have been encountered while achieving decannulation following laryngotracheal reconstruction. An approach to such frustrating problems as suprastomal collapse, granulation tissue, and the inability to decannulate are presented.