Management of complex pediatric laryngotracheal stenosis with skin graft reconstruction

Publication date: Available online 15 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Sarah N. Bowe, Carissa J. Wentland, G.S. Sandhu, Christopher J. Hartnick
ObjectivesFor pediatric patients with laryngotracheal stenosis, the ultimate goal is creation of a safe, functional airway. Unfortunately, wound healing in a hollow structure can complicate repair attempts, leading to restenosis. Herein, we present our experience using skin-grafting techniques in a series of two complex pediatric laryngotracheal stenosis cases, leading to successful decannulation or speech production.MethodsA chart review was performed examining the evaluation and management of two pediatric patients with laryngotracheal stenosis despite prior reconstructive attempts. Patient history, bronchoscopic evaluation, intra-operative technique, post-operative management, treatment outcomes, and complications were noted. Harvesting and preparation of the split-thickness skin grafts (STSG) proceeded in a similar manner for each case. Stenting material varied based on the clinical scenario.ResultsUsing this technique, a patient with Type 3 glottic web achieved substantial improvement in exercise tolerance, as well as vocal strength and quality. Furthermore, both nearly aphonic patients could vocalize for the first time since their laryngotracheal injures.ConclusionsTemporary endoluminal stenting with skin graft lining can reproduce epithelial continuity and provide "biological inhibition" to enhance the wound healing process. When previous reconstructive efforts have failed, use of STSG can be considered in the management of complex pediatric laryngotracheal stenosis.



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