Ann Thorac Surg 2007;84:675
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Blood Supply of the Trachea and Proximal Bronchi
Marvin F. Sturridge, MS, FRCSa,
Michael R. Mueller, MDb,
Tom Treasure, MS, MDc,*
a Crendon, Felpham, West Sussex, England
b University Klinik für Chirurgie, Klinik Abt. für Herz-Thoraxchirurgie, Vienna, Austria
c Guy’s Hospital, London, England
* Address correspondence to Dr Treasure, Guy’s Hospital, St. Thomas St, London, SE1 9RT England (Email: tom.treasure{at}gmail.com).
The recent publication by Getman and colleagues [1] on the blood supply of the bronchial stump stirred memories of previous work on the subject. In the early 1960s, Marvin Sturridge [2] working at the Brompton Hospital in London undertook research into bronchopleural fistula. In the course of this work, he investigated the blood supply of the trachea and the proximal bronchi, and produced the accompanying image (Fig 1).
Whole blocks of thoracic viscera were mobilized by ligating and dividing the aorta at the diaphragm, and its major and intercostal branches. Blood was cleared by flushing with 500 mL normal saline at 37°C. The blocks were immersed in a water bath at 40°C for 1 hour so that the opaque medium would remain liquid for the duration of the injection. Gelatin (75 g) was stirred into 500 mL micropaque heated to 40°C to 42°C until fully dissolved, filtered through gauze, rewarmed, and injected into the warmed blocks at 120 mm Hg pressure until 400 mL had entered or no more would go in, usually 5 to 15 minutes. The water bath was drained and refilled with cold water to set the gelatin for more than 1 hour. The blocks were then fixed in 10% formol saline for 48 hours. The specimens were further dissected and radiographs taken. The sparse longitudinal vessels can be seen, and it can be appreciated how vulnerable the blood supply is to overenthusiastic dissection in the region of the carina.
Longitudinal sections of uninjected tracheas were prepared for histologic examination to determine the diameter of the intercartilaginous vessels using a calibrated reticule on the microscope. Twenty-four of 29 vessels had diameters less than 0.1 mm, fitting an anatomical definition of arterioles.
Salassa and coworkers [3] reported their landmark study in The Annals of Thoracic Surgery in 1977. The work of Sturridge [2] was included in a thesis for the University of London Master of Surgery degree awarded in 1965. The findings informed teaching and practice in subsequent years [4], but the work itself has not been previously published, other than in the thesis in the Brompton Hospital and University of London libraries. That was the way in England in those times.
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References
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- Getman V, Devyatko E, Abraham D, et al. Reconstitution of blood supply of the denuded bronchial stump Ann Thorac Surg 2005;80:2063-2069.[Abstract/Free Full Text]
- Sturridge M. Bronchopleural fistula following pneumonectomy for carcinoma. 1965[thesis]. MS (Med) held in Senate House Library, University of London.
- Salassa JR, Pearson BW, Payne WS. Gross and microscopical blood supply of the trachea Ann Thorac Surg 1977;24:100-107.[Abstract]
- Sturridge M. Bronchopleural fistula after pneumonectomyIn: Jackson J, editor. Operative surgery. 3rd ed.. London, England: Butterworths; 1978. pp. 340-346.
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