Hyperbaric oxygen therapy for the treatment of anastomotic complications after tracheal resection and reconstruction

Cameron Stock, Natalie Gukasyan, Ashok Muniappan, Cameron Wright, Douglas Mathisen

Research output: Contribution to journalArticle

Abstract

Objective: Failure of anastomotic healing is a rare but serious complication of laryngotracheal resection. Treatment options include reoperation, tracheostomy, or T-tube placement. Hyperbaric oxygen therapy (HBOT) is the delivery of 100% O2 at pressures greater than 1 atm, and has been shown to enhance wound healing after tracheal resection in animal models. To date, there have been no reports describing its usefulness in humans after tracheal resection. Methods: Five consecutive patients with varying degrees of failed anastomotic healing, from necrotic cartilage to partial separation identified by bronchoscopy were treated with HBOT. HBOT was administered for 90 minutes via a hyperbaric chamber pressurized to 2 atm with 100% oxygen. Patients were treated with daily or twice daily HBOT. Four of 5 patients had buttressing of the anastomosis by strap muscle at the initial surgery. Results: All patients had evidence of anastomotic healing on bronchoscopy. None of the patients in this series required tracheostomy, T-tube, or reoperation after initiation of HBOT. On average it took 9.6 days for healing to occur (5-14 days). The size of the anastomotic defect ranged between 3 and 13 mm. One patient required bilateral tympanostomy tubes for inner ear discomfort and experienced blurry vision as complications of HBOT. One patient developed tracheal stenosis from granulation tissue that required bronchoscopic debridement. Conclusions: In select patients with anastomotic complications after tracheal resection, HBOT may aid in healing and avoid tracheostomy. Future investigations are necessary to further define the benefits of HBOT in the management of airway anastomotic complications.

Original languageEnglish (US)
Pages (from-to)1030-1035
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

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Reconstructive Surgical Procedures
Surgical Anastomosis
Hyperbaric Oxygenation
Tracheotomy
X Ray Computed Tomography
Bronchoscopy
Trachea
Wound Healing
Young Adult
Retrospective Studies
Tracheostomy
Therapeutics
Reoperation
Middle Ear Ventilation
Tracheal Stenosis
Airway Management
Granulation Tissue
Inner Ear
Debridement
Cartilage

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hyperbaric oxygen therapy for the treatment of anastomotic complications after tracheal resection and reconstruction. / Stock, Cameron; Gukasyan, Natalie; Muniappan, Ashok; Wright, Cameron; Mathisen, Douglas.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 3, 01.03.2014, p. 1030-1035.

Research output: Contribution to journalArticle

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