Injuries of the Posterior Tracheal Wall: Insights from a High-Volume Single-Centre Experience

Background: Major airway injuries, regardless of whether their aetiology is traumatic or iatrogenic, are rare but potentially fatal. In selected cases, surgery plays a key role; however, it has to be performed by highly experienced professionals in emergency settings. Methods: We reviewed all surgical procedures involving the trachea which were performed at our institution in the last 5 years (365 procedures). We report here our experiences with major airway injuries, both traumatic and iatrogenic (19 procedures). All patients, including individuals from within our hospital and from other peripheral centres, were treated in an emergency setting within 12 h of correct diagnosis. Results: The location and extent of tracheal lesions can be different in every patient. After a proper evaluation with CT scan and bronchoscopy, we approached all our cases of tracheal injuries with a cervicotomy, using, in some selected cases, an endoscopic camera to better visualise lesions that involved the carina. However, in extremely severe cases, such as one we report here, where multiple repair attempts fail and tissue viability is compromised, demolitive surgery by means of posterolateral thoracotomy may represent the only remaining therapeutic option. Conclusions: Surgery on tracheal injuries is complex, highly specialised, and time-dependent. In selected cases, it has to be performed quickly by highly qualified professionals after proper evaluation in an emergency setting. Every airway injury differs in its location, extent, aetiology, and clinical presentation, and there is no unanimous consensus on standardising treatment. Only high-volume centres with highly experienced professionals can guarantee correct management of this rare but life-threatening event.