A new method of tracheal reconstruction.

When resection of more than 50% of the trachea is necessary, tracheal reconstruction becomes a very difficult problem. We tested a new method of tracheal reconstruction using the left main bronchus. The procedure was performed in 6 adult mongrel dogs. Through a midline sternotomy, a left pneumonectomy is performed, preserving as much of the left main bronchus as possible. The carina is preserved and mobilized, and the left main bronchus is passed under the aortic arch and reversed. The distal end of the bronchus is anastomosed to the proximal end of the resected trachea. The distal end of the resected trachea is closed by stapling. Four animals survived the procedure without apparent functional difficulty and remained healthy until they were killed five to ten months postoperatively. The anastomosis was well healed without stenosis. Anatomical measurements in 10 human cadavers revealed that the length of the left main bronchus to the level of the upper lobe takeoff is approximately 50% that of the trachea. The diameter of the left main bronchus is approximately 75% that of the trachea. We believe that the technique described can extend the limits of tracheal resection in a selected group of patients for whom there is currently no good alternative.