Casiano R A, Patete M, Lindquist T
Department of Otolaryngology, University of Miami School of Medicine, FL.
Otolaryngol Head Neck Surg. 1994 Sep;111(3 Pt 1):205-10. doi: 10.1177/01945998941113P108.
The reasons for unsuccessful decannulation after a laryngotracheoplasty may be multifactorial depending on the techniques used. Excessive granulation tissue may develop, necessitating further adjunctive procedures. Cartilaginous grafts may get infected, resorb, or collapse into the tracheal lumen. Bulky regional skin-muscle flaps may dehisce under tension or collapse into the tracheal lumen. Medial migration of the split ends of the anterior cartilaginous tracheal rings ensues with subsequent restenosis. Donor-site morbidity may compound these problems as well. During a 2.5-year period, we have performed laryngotracheoplasty on nine patients with 60% to 100% tracheal stenosis using titanium reconstruction plates. The split anterior tracheal wall is fixed by the plates in its expanded position. A neurovascularized strap-muscle flap is used to reconstruct the anterior tracheal wall. The flap becomes epithelialized with squamous epithelium within 3 weeks. Successful decannulation was possible in seven of the nine (78%) patients with no further respiratory problems. Of these, six required no further procedures. This technique offers a viable simple alternative to other methods of laryngotracheoplasty without the need for donor cartilage grafts or thick bulky skin-muscle flaps.
根据所采用的技术，喉气管成形术后拔管失败的原因可能是多方面的。可能会形成过多的肉芽组织，需要进一步的辅助治疗。软骨移植物可能会感染、吸收或塌陷至气管腔内。体积较大的局部皮肤肌肉瓣可能会在张力作用下裂开或塌陷至气管腔内。气管前软骨环断端向内侧移位，随后出现再狭窄。供区并发症也可能使这些问题更加复杂。在2.5年的时间里，我们对9例气管狭窄60%至100%的患者进行了喉气管成形术，使用钛重建板。气管前壁劈开处通过钛板固定在扩张位置。采用带血管蒂的带状肌瓣重建气管前壁。该皮瓣在3周内被鳞状上皮上皮化。9例患者中有7例（78%）成功拔管，无进一步的呼吸问题。其中，6例无需进一步治疗。该技术为其他喉气管成形术方法提供了一种可行的简单替代方案，无需供体软骨移植或厚大的皮肤肌肉瓣。
