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2016 ; 8
(Suppl 2
): S113-20
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Surgery of the airway: historic notes
#MMPMID26981261
Cooper JD
J Thorac Dis
2016[Mar]; 8
(Suppl 2
): S113-20
PMID26981261
show ga
Prior to the 20(th) century, the need for surgical procedures on the airway was
infrequent and consisted mainly of tracheostomy to relieve airway obstruction or
repair of tracheal injuries such as lacerations. Even the ability of tracheal
suture lines to heal primarily was viewed with concern due to the rigidity of the
tracheal wall, its precarious blood supply and uncertainty as to whether the
cartilage components could heal without complications. In the 20(th) century the
evolution of tracheal procedures on major airways evolved to meet the challenges
provided by the expanding fields of thoracic surgery and advent of mechanical
respiratory support with its associated complications. In the first half of the
century lobar and lung resections done for tuberculosis and lung cancer required
methods for safe closure of the resulting bronchial stumps and end-to-end
bronchial anastomosis in the case of sleeve resections of the lung. Beginning in
mid-century the advent of respiratory care units for the treatment of polio and
for the expanding fields of thoracic and cardiac surgery resulted in a
significant number of post-intubation tracheal stenosis requiring resection and
primary repair. In the last 20 years of the century the development of lung
transplantation with its requirement for successful bronchial anastomoses between
the donor and recipient bronchi, created unique challenges including ischemia of
the donor bronchus the adverse effects of immunosuppression, donor lung
preservation and diagnosis and management of post-transplant infection and
rejection.
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