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J Thorac Cardiovasc Surg 1997;114:870
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Complex reconstruction of the right bronchial system

Horia Sirbu , MD, Bernd Herse , MD, Thomas Busch , MD, Harald Dalichau , MD

Department of Thoracic and Cardiovascular Surgery
University of Göttingen
Robert Koch Str. 40
D-37075 Göttingen, Germany

To the Editor:

We read with great interest the recent article by Muysoms and van SwietenGo 1 in the February 1997 issue of the Journal on primary repair of the rupture of the main and lobar bronchus. Little has been published on this topic.

Emergency bronchial reconstruction is always challenging, even for an experienced surgeon, and the authors should be congratulated for their result. WeGo 2 previously reported successful surgery in a similar case of complex disruption of the right bronchial system. Emergency bronchoscopy is useful to establish the site, nature, and sometimes the extent of the bronchial rupture. It should be performed whenever possible for critical intrathoracic injuries after blunt chest trauma.Go 3 However, in our view one should not spend too much time with bronchoscopy or other invasive endoscopical procedures. Emergency thoracotomy is always necessary to evaluate the degree of bronchial rupture, the possibility of reconstruction, the presence or absence of associated lung contusions, and sometimes as a resuscitative measure.

Major pulmonary resection in these patients, who are often in prolonged shock, is associated with a high mortality.Go 4 Go 5 Therefore intitial bronchial reconstruction should always be attempted to avoid early and late complications and to preserve uninjured lung areas for an adequate gas exchange.

In the past, ruptured bronchi have been repaired and other bronchial anastomoses have been performed with nonabsorbable sutures. However, anastomotic complications have been prevalent.Go 3 We are using monofilar, slowly absorbable 4-0 PDS polydioxanone (Ethicon, Inc., Somerville, N.J.) for bronchial sutures, and we have observed no major anastomotic complications.

Follow-up bronchoscopy performed 12 months later in our case showed an almost normal bronchial lumen with no anastomotic stenosis.Go 2

From our experience, we encourage primary bronchial reconstruction even in the case of complex ruptures rather than major pulmonary resection, a functionally much less satisfactory solution.

12/8/84949

References

  1. Muysoms EF, van Swieten AH. Primary repair of rupture of a main lobar bronchus. J Thorac Cardiovasc Surg 1997;113:415-7. [Free Full Text]
  2. Sirbu H, Herse B, Schorn B, Huttemann U, Dalichau H. Successful surgery after complete disruption of the right bronchial system. Thorac Cardiovasc Surg 1995;43:239-41. [Medline]
  3. Taskinen SO, Salo JA, Halttunen PEA. Tracheobronchial rupture due to blunt chest trauma: a follow-up study. Ann Thorac Surg 1989;48:846-9. [Abstract]
  4. Thompson DA, Rowlands BJ, Walker WE, Kuykendall RC, Miller PW, Fischer RP. Urgent thoracotomy for pulmonary or tracheobronchial injury. J Trauma 1988;28:276-9. [Medline]
  5. Bowling R, Mavroudis C, Richardson JD, Flint LM, Howe WR, Gray LA Jr. Emergency pneumonectomy for penetrating and blunt trauma. Am Surg 1985;51:137-43.



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This Article
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