Ann Thorac Surg 1996;62:280
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Hermes C. Grillo, MD
Department of Thoracic Surgery, Massachusetts General Hospital, Thoracic Surgical Unit/Warren 1101, 55 Fruit St, Boston, MA 02114
See also page 278.
The positional hypothesis remains unproven, but the fact that at least one other similar occurrence has been anecdotally described by a group with a small experience in tracheal surgery, as well as Domínguez and associates' citations of complications reported in the literature from like positioning, raise a cautionary signal. My colleagues and I have not seen this complication in approximately 1,000 tracheal reconstructions managed with a "guardian suture" or sutures. I am not aware of its occurrence in the world's larger series reported from Canada, France, Russia, and Brazil.
It should be carefully noted, however, that the guardian suture does not hold the chin to the chest-a position of extreme flexion-but rather maintains the gently flexed position required for anastomosis. This usually is only a little past the neutral cervical position. The purpose of the suture is to prevent inadvertent hyperextension during sleep-not to fix the chin to the chest. Domínguez and associates state that "the neck was kept in flexion by suturing the chin to the anterior chest wall" (my italics). This has never been done in our patients and I do not believe should ever be done. This apparent misconstrual of technique must be corrected in the minds of all who perform tracheal resection and reconstruction.
Related Article
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Irreversible Tetraplegia After Tracheal Resection
- Jaime Domínguez, Juan J. Rivas, Ramiro D. Lobato, Vicente Díaz, and Emilio Larrú
Ann. Thorac. Surg. 1996 62: 278-280.
[Abstract]
[Full Text]
