[Tracheoplasty for tracheal cuff stenosis post long-term tracheostomy].

Area of Science:

• Cardiothoracic Surgery
• Pulmonology
• Intensive Care Medicine

Background:

• Tracheostomy is a common procedure for prolonged mechanical ventilation.
• Complications can include tracheal stenosis, particularly at the cuff site.
• Ventricular septal defect (VSD) patients may require extended ventilation due to cardiac and pulmonary issues.

Observation:

• A 43-year-old male with VSD developed severe tracheal stenosis (cuff stenosis) 4 months post-tracheostomy.
• Bronchofiberscopy revealed circumferential stenosis 4 cm below the tracheostomy site, correlating with the endotracheal tube cuff.
• Initial dilation provided temporary relief, but restenosis occurred within weeks.

Findings:

• End-to-end suture tracheoplasty following resection of the stenotic segment (2 cm, 4 tracheal rings) was performed.
• This surgical intervention successfully addressed the severe airway obstruction.
• Tracheoplasty proved to be the most reliable method for managing this complication.

Implications:

• This case highlights the risk of cuff stenosis following prolonged tracheostomy.
• Early recognition and appropriate management are crucial for preventing severe airway compromise.
• Surgical tracheoplasty should be considered the gold standard for refractory or severe cuff stenosis.