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Effect of stenting on graft vascularization after laryngotracheoplasty
T C Logan1, D E Henrich, W W Shockley
1Division of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill.
Insights
In pediatric airway stenosis management, this study found that using stents after laryngotracheoplasty with cartilage grafts significantly increased graft vascularization. Stenting did not inhibit early wound healing in this animal model.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Regenerative Medicine
Background:
- Pediatric airway stenosis is a growing concern, often requiring prolonged intubation in neonates.
- Laryngotracheoplasty with cartilage grafting is a preferred surgical approach for severe cases.
- The role of stents in airway reconstruction remains controversial, with potential benefits for support versus risks of impaired healing.
Purpose of the Study:
- To investigate the effect of stenting on the vascularization of cartilaginous grafts in an animal model of pediatric airway stenosis.
- To compare wound healing and graft vascularization rates between stented and non-stented laryngotracheoplasty procedures.
Main Methods:
- Thirty-six New Zealand white rabbits underwent laryngotracheoplasty with autogenous cartilage grafting.
- Half of the rabbits received a stent (endotracheal tube section) below the glottis.
- Graft vascularization was assessed using a computerized image measurement program at multiple time points (days 4-21).
Main Results:
- Gross and histologic examinations showed similar wound healing in both stented and non-stented groups.
- The stented group demonstrated a statistically significant increase in graft vascularization compared to the non-stented group (73% vs. 55% at day 10; p < .05).
Conclusions:
- Stenting after laryngotracheoplasty with cartilage grafting does not appear to inhibit early wound healing.
- Stenting may enhance, rather than impede, early graft vascularization in this model, potentially supporting airway reconstruction outcomes.
Abstract:
The management of pediatric airway stenosis has been an important topic of debate over the last few decades as prolonged intubation has become more common in the neonate. Although many surgical options are available, most would agree that use of expansion techniques (laryngotracheoplasty) with cartilaginous grafting is the procedure of choice for the severely stenotic airway. Controversy persists, however, regarding the role of stents. Advocates feel that stents serve to counteract scar contracture and support the newly constructed airway. In contrast, recent studies suggest that stenting results in impaired wound healing and an increased complication rate. The present study addresses the effect of stenting on the vascularization of cartilaginous grafts in an animal model. Thirty-six New Zealand white rabbits were evaluated after laryngotracheoplasty with autogenous cartilage grafting. Half of the animals were stented with a 2-cm section of an endotracheal tube that was secured just below the glottis. Three rabbits from each group were then painlessly sacrificed on days 4, 6, 8, 10, 14, and 21. Gross and histologic comparisons of the stented and nonstented specimens revealed similar wound healing. Measurements of graft vascularization were obtained with a computerized image measurement program, and a comparison was made regarding the rate of vascularization. There was a statistically significant increase in the rate of vascularization in the stented group (mean 73% versus 55% at day 10; p < .05). This analysis suggests that stenting does not inhibit early wound healing and specifically graft vascularization after laryngotracheoplasty.