Surgery for Membranous Tracheomalacia: Tracheobronchoplasty

The authors present a 59-year-old woman with a history of asthma, episodes of bronchospasm, and multiple ICU readmissions requiring orotracheal intubation. After a trial period with a tracheobronchial Y-shaped silicone stent (DumonTM stent), a tracheobronchoplasty was indicated as a definitive surgical treatment.

The objective of surgery was to stabilize and add rigidity to the membranous wall of the trachea in order to prevent intrusion of the membranous wall into the lumen of the airway.

The surgery was performed through a right fourth intercostal space thoracotomy. The posterior airway was fully exposed from the thoracic inlet to the main bronchi after the azygos vein was transected. The posterior wall of the trachea and both main bronchi were anchored to a high-density polypropylene mesh (Marlex mesh; Marlex, C.R. Bard, Inc., Covington, GA, USA) with a series of four mattress sutures of 4-0 polydioxanone II, placed in a partial thickness fashion.

The patient was discharged on the 10th postoperative day without complications. One year after the operation, the patient presented with significant symptomatic relief and improvement of her quality of life. Surveillance bronchoscopies showed a stable membranous wall with no intrusion into the lumen of the airway.

In conclusion, surgical stabilization of the airway by tracheobronchoplasty effectively and permanently corrects malacic airways. Proper surgical selection is facilitated by a short-term stent trial.

References

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