[Tracheobronchial injuries and fistulas]

In association with perforating or blunt trauma, isolated injuries of the trachea and the bronchi are rarely seen. More frequently, however, they occur when adjacent organs or structures are involved, thus creating very complex syndromes. Symptoms such as dyspnea, coughing attacks, hemoptysis, soft tissue emphysema, cyanosis, and pneumothorax should point to severe tracheobronchial injuries. Diagnosis is confirmed through an emergency tracheobronchoscopy; early surgical repair is mandatory. Iatrogenic injuries--most often due to intubation maneuvers--are infrequent but potentially life-threatening and demanding immediate repair except in cases with superficial tears. Leading symptoms of transmural lacerations are dyspnea, soft tissue emphysema, and pneumothorax. Tracheoesophageal fistulas result from decubital necrosis caused by long-term intubation. With spontaneous healing never occurring, surgical repair is carried out ideally by closing both openings in chronic fistulas, while simultaneous tracheal stenosis is treated by segmental resection. Tracheoarterial fistulas, mostly associated with tracheostomy, become fatal if not detected immediately. Definitive repair requires the resection of the vascular segment involved.