Repair of tracheal intubation injuries

Occult tracheal injuries occurring at the time of intubation frequently leave a posterior defect and lead to the rapid development of mediastinal infection. Some protection is provided by the endotracheal tube, which may further contribute to delay in diagnosis. Current descriptions of tracheal reconstruction emphasize circumferential excision and reanastomosis, but advanced infection and a probable need for ventilatory support are considered contraindications. Two cases of tracheal injury are reported in which a considerable delay in diagnosis resulted in severe mediastinal infection and respiratory failure. Use of an earlier method of tracheal repair, with pedicled intercostal muscle, resulted in control of mediastinal infection. Respiratory failure was treated effectively with a volume ventilator. It is recommended that the operation be given first consideration for such posterior injuries when they are accompanied by infection or respiratory failure.