[Rib cartilage graft laryngotracheal reconstruction for severe laryngotracheal stenosis]

To study the success and failure factors with rib cartilage graft laryngotracheal reconstruction for severe laryngotracheal stenosis for improving the rate of successful decannulation.

Thirty-six cases with severe laryngotracheal stenosis, received rib cartilage graft for laryngotracheal reconstruction during the last 18 years in our hospital, were analyzed retrospectively.

Twenty-nine of the 36 patients (80.5%) were successfully decannulated after one procedure. The follow-up time ranged from 1 to 10 years. All of the 29 patients had a stable airway and normal exercise tolerance. The duration of T-tube stent was 10 days to one year (average 3 months). Seven patients (19.5%) failed to decannulate. The factors of failure were disturbance of local blood circulation, wound infection followed rib necrosis, T-tube injured mucomembrane then became a new stenosis, and restenosis for scar constitution.

Laryngotracheal reconstraction with rib cartilage graft is one of effective method for severe laryngotracheal stenosis. The procedure is relatively simple, and shorter duration of stenting and higher rate of success. The drawbacks of this technique are ischemia necrosis easily occurred for isolated cartilage and required additional surgery for the donor sit. The patient with scar constitution or undertaken radiotherapy is contraindications. All the managements, appropriate selection of patients, diligent postoperative care, prevented wound infection and using T-tube properly, may increase the rate of successful decannulation. PJP].