Ebook Head and neck surgery - Reconstructive surgery: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Head and neck surgery - Reconstructive surgery: Part 2
Ebook Head and neck surgery - Reconstructive surgery: Part 2
PART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2s back more than 200 years. While many initially viewed the Iracltea as merely an airway conduit that could be replaced by an alloplastic tube, investigators and surgeons have gained a greater respect for die complex biology of die airway. Tire tracheal airway plays a critical role in mucociliary tr Ebook Head and neck surgery - Reconstructive surgery: Part 2ansport. airway hygiene, and antigen processing. Ideally, reconstructive techniques should strive to maintain these important functions.Tracheal airwaEbook Head and neck surgery - Reconstructive surgery: Part 2
y defects can be classified into three categories: Defects less than 4 cm. defects between 4 and 6 cm. and defects greater than 6 cm in length. DefectPART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2cts greater than 6 cm continue to represent a reconstructive dilemma; although a variety of techniques have been used to manage the latter group including allograft reconstruction. alloplastic reconstitution, and tracheal transplantation. none has proven effective.HISTORYA careful prcopcrative histo Ebook Head and neck surgery - Reconstructive surgery: Part 2ry and physical examination arc essential. I feel that a detailed history is important in trying to understand die nature of die traclreal problem parEbook Head and neck surgery - Reconstructive surgery: Part 2
ticularly a history of prior surgery, infection, and compromised wound healing. The underlying cause of the tracheal problem is important because it wPART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2a, tumor resection, congenital stenosis, inhalational injuty. or acquired idiopathic disease. While defects from trauma and tumor resection are often focal in nature, congenital and inhalational tracheal disease may result in more diffuse injury and therefore more extensive defects. In contrast, idi Ebook Head and neck surgery - Reconstructive surgery: Part 2opathic disease often involves the cricoid cartilage and therefore presents a separate set of challenges. A thorough history can help to elucidate theEbook Head and neck surgery - Reconstructive surgery: Part 2
underlying cause of die tracheal disease as well as to predict tl*e nature of the defect and the best approach for reconstruction.Factors of a generaPART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2 a catastrophic complication. Patients with brittle diabetes, collagen vascular disease, or prior surgery represent the greatest challenge.PHYSICAL EXAMINATIONThe physical examination includes both preoperative and intraoperative evaluations. Prcopcrativcly. pulmonary function studies, computed tomo Ebook Head and neck surgery - Reconstructive surgery: Part 2graphy (CT), and endoscopy represent the three pillars of the evaluation. The pulmonary function studies are not essential for every patient but may pEbook Head and neck surgery - Reconstructive surgery: Part 2
rovide information2^5(c) 2015 Wolters Kluwer. All Rights Reserved.216PARTV RêvVl»ự*l WVIIVII V* UIV LMI Ịttrv llựl^rouFIGURE 27.1A.B. ĩte tìigh-resoluPART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2t te appreciated on office erriosoopy.about whether the airway obstruction is fixed or dynamic. Dynamic obstruction, such as tracheomalacia and vascular compression syndrome. IS often more challenging to manage than is focal fixed obstruction. The CT scan and the endoscopic evaluations often provide Ebook Head and neck surgery - Reconstructive surgery: Part 2 information related to the length and site of the stenosis. Flexible tracheoscopy can be performed in the office to evaluate the airway and determineEbook Head and neck surgery - Reconstructive surgery: Part 2
if an obstruction is dynamic or fixed. Unfortunately, not all patients will tolerate such an examination The high-resolution CT scan (1-mm cuts) is aPART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2t information (Fig. 27.1 A and B). Three-dimensional reconstruction can also provide important information related to the site of the Stenosis (Fig. 27.2).Tl>e intraoperative endoscopy typically provides the best examination. A rigid fiberoptic endoscope provides a high-resolution evaluation of the Ebook Head and neck surgery - Reconstructive surgery: Part 2airway that can be exceptionally helpful in determining the nature of the disease and predict the best approach to reconstruction (Fig. 27.3).INDICATIEbook Head and neck surgery - Reconstructive surgery: Part 2
ONSThe indications for primary (end-to-end) tracheal reconstruction arc defects that arc less than 4 cm in length. In select patients, defects that arPART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2owever, these techniques impede elevation of the larynx dunng swallowing and may result in aspiration.FIGURE 27.2Three-dimensicrel reconstruction can provide important information related 10 (Tie site of tf-e stenosis(c) 2015 Wolters Kluwer. All Rights Reserved.CHAPTER 27 Primary Reconstruction OÍ t Ebook Head and neck surgery - Reconstructive surgery: Part 2he TracheaCONTRAINDICATIONSFIGURE 27.3High-resolution endoscopy ol a tracheal lesion.The contraindications to primary tracheal reconstruction arc patiEbook Head and neck surgery - Reconstructive surgery: Part 2
ents with defects greater than 6 cm in length and patients with defects greater than 4 cm in length if there is a history of a previously failed reconPART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2h patient should be evaluated as such, Most contraindications arc “relative” contraindications. The patient's anatomy, body habitus, and personal disposition all play a role in the decision-making process concerning reconstruction.PREOPERATIVE PLANNINGPrior to surgery. I evaluate airway resistance i Ebook Head and neck surgery - Reconstructive surgery: Part 2n all subjects. A flow-volume loop is generated by having the patient inhale deeply to total lung capacity (TLC). forcefully exhale until the lungs haEbook Head and neck surgery - Reconstructive surgery: Part 2
ve been emptied to residual volume, and rapidly inhale to reach TLC. A maximal expiratory flow 50%: Maximal inspiratory flow 50% ratio is. therefore, PART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2inished (0.2 or less). In fixed obstructions, the ratio is expected to be close to 1. This study provides an excellent method to determine diagnosis and eligibility for surgery.SURGICAL TECHNIQUEPrimary reconstruction of tlie trachea can be achieved through a straight end-to-end technique or a slidi Ebook Head and neck surgery - Reconstructive surgery: Part 2ng technique depending on the defect and the needs of the patient. Independent of the approach, the basic technique is similar. Prior to oral-trachealEbook Head and neck surgery - Reconstructive surgery: Part 2
intubation. I perform a ngtd endoscopy using an apneic technique or with a ventilating bronchoscope. This provides an opportunity to reevaluate lire PART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2, and the standard sterile preparation is performed. Tl>e neck is exposed through a standard collar incision. The trachea is exposed through a midline strap-splitting approach.The trachea is isolated by dissecting along it with Mctzcnbaum -scissors and bipolar cautery to achieve a bloodless field. C Ebook Head and neck surgery - Reconstructive surgery: Part 2areful attention is dedicated to the recurrent laryngeal nerves, and as the dissection progresses peripherally, lire soft tissue enveloping live recurEbook Head and neck surgery - Reconstructive surgery: Part 2
rent laryngeal nerves is gently dissected off of the trachea.Once the trachea is isolated, the cuff of the endotracheal tube is deflated and a transvePART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction dates Ebook Head and neck surgery - Reconstructive surgery: Part 2 and the membranous posterior segment.PART V: RECONSTRUCTION OF THE LARYNX/TRACHEAPRIMARY RECONSTRUCTIONOF THE TRACHEAEric M. GendenINTRODUCTIONThe history of tracheal reconstruction datesGọi ngay
Chat zalo
Facebook