Reconstruction Of The Trachea

Dissection is performed close to the trachea to avoid injurying the recurrent nerves, especially near the cricoid cartilage. Direct isolation of the nerves is avoided. The trachea is approximated after resection while the neck is flexed by the anesthesiologist and this demonstrates whether further mobilization using the previously discussed techniques may be necessary. Interrupted sutures are placed, usually 4-0 Vicryl, although in some friable tissues 4-0 Prolene may be necessary on pledgets.

For reconstruction of the lower trachea, anatomic mobilization is accomplished prior to severing the trachea since this allows improved exposure and handling of the trachea. It is important to note that laryngeal release is not helpful in performing resection of the carina, however the other maneuvers, i.e. hilar release and neck flexion are extremely helpful. Figure 24.2 a-b, 24.3 .a-b and 24. 4a-b show surgical techniques for procedures involving the upper and lower trachea.

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