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Ann Thorac Surg 2007;83:1924
© 2007 The Society of Thoracic Surgeons

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Correspondence

Reply

Department of General Thoracic and Abdominal Surgery and Department of Anesthesiology, S. Eugenio Hospital, Piazzale dell’Umanesimo 10, Rome, 00144 Italy

(Email: e.mercadante{at}tiscali.it).

To the Editor:

We thank Dr Baciewicz [1] for his remarks and we appreciate his comments on our article [2] regarding conservative treatment of a major iatrogenic tracheal injury. He focused his comments on the opportunity to place a tracheal stent to allow early extubation and to avoid endotracheal tube migration or damage to the left bronchial stump.

We evaluated a tracheal stent as a valid option to treat our patient, but we considered the following contraindications: a silicon tracheal stent is fixed in the correct position by the radial force pushing outside. A stable point of tracheal wall is needed to anchor the stent, as is available in the stenosis. If the stent is used to protect a tracheal laceration, at least 1 cm of healthy trachea is needed upstream and downstream from the tear. To protect the left bronchial stump, as suggested by Baciewicz [1], the distal end of the stent should be placed in the right main bronchus. Because the laceration was 7 cm long, the stent would be at least 9 to 10 cm long, which is a very long stent associated with high morbidity and patient discomfort. Moreover, the radial force applied to the tracheal wall by the stent could extend the laceration and lead to migration of the stent into the mediastinum. A prosthesis precludes monitoring the healing process and impairs mucus transport of both the tear and airway. This does not occur with an oro-tracheal tube, which is maintained in the correct position in the right main bronchus by the distal cuff and which can be easily removed to perform daily fiberoptic bronchoscopy. In our opinion these advantages were the cornerstones of the patient’s recovery.

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1. Baciewicz FA. Alternative conservative therapy(letter) Ann Thorac Surg 2007;83:1923.[Free Full Text]
2. Mercadante E, Giovannini C, Castaldi F, et al. Major iatrogenic tracheal injury after pneumonectomy: conservative treatment Ann Thorac Surg 2006;81:2285-2287.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Edoardo Mercadante Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mercadante, E. Articles by Carlini, M. Search for Related Content PubMed Articles by Mercadante, E. Articles by Carlini, M. Related Collections Related Article