Tracheal reconstruction without the use of grafts.

Bronchial anastomosis is now a practicable procedure. It was first successfully performed in dogs and reported by Jackson, Lafkin, Tuttle, and Hampton (1949), and in that same year Tuttle described the first successful anastomosis in the human subject after accidental division of a major bronchus. Later reports followed (Mathey and Oustrieres, 1951), and tne healing properties of the bronchial tree, including the trachea, were established. In resection of the trachea, the ideal repair would seem to be end-to-end anastomosis of the severed ends. Because the lower end of the trachea is fixed by the passage of the left main bronchus under the aortic arch, and the elasticity of the bronchial tree is limited, only a small segment can be completely excised and the repair effected in this way. Rob and Bateman (1949) in studies of six fresh human cadavers estimated that a 2-cm. segment is the largest that can be excised from the human trachea and the ends united without undue tension on the suture line. This does not permit radical resection of a tracheal tumour. Consequently most procedures on reconstruction of the trachea concern the use of grafts. We now report a case of cylindroma involving the lower end of the trachea, carina, and the origins of the right and left main bronchi. The tumour-bearing area, 5 cm. in length, was excised and the subsequent large defect closed using a new technique of mobilization and bronchial anastomosis without resort to grafts and without sacrifice of lung tissue.