T-Graft for Single Stage Laryngotracheal Reconstruction: Revisiting a Previously Described Technique

Use of costal cartilage grafts for longer segment anterior graft laryngotracheal reconstruction can pose a risk for the inferior aspect of the graft prolapsing into the airway lumen. This is particularly true when incorporating a tracheostoma into the reconstruction. Use of two costal cartilage grafts combined to form an inverted T-shape can be helpful in addressing this issue. This technique has been previously described in two reports but is not widely used. We review the technical aspects of this approach and outcomes in two patients.

Two pediatric patients with subglottic/tracheal stenosis and tracheostomy underwent SS-LTR using inverted T-shaped costal cartilage grafts. The vertical limb was secured to expand the subglottic/proximal tracheal airway, while the horizontal segment provided wider coverage of the stomal defect and supported the inferior aspect of the vertical limb. The technical details and postoperative course are reviewed.

Both patients exhibited successful airway healing without evidence of graft prolapse or dehiscence. The T-graft supported the inferior aspect of the reconstruction effectively and closed the stomal defect without tension. Follow-up endoscopic evaluation confirmed a patent airway with stable graft integration. Serial excision of foci of granulation was required postoperatively.

The previously described but infrequently reported inverted T-graft technique is a useful approach for longer segment stenosis. Larger series with longer follow-up are needed to clarify long-term outcomes.

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