Management of complications of tracheal surgery.

Basic principles of tracheal reconstruction, which were introduced in the 1960s and 1970s, served to reduce the prevalence of many complications. These principles include thorough preoperative assessment (endoscopic and radiologic) of the tracheal anatomy and glottic function, avoidance of excessive anastomotic tension, preservation of tracheal blood supply, and meticulous dissection and anastomosis. The tracheal surgeon should have access to expert help in radiology and anesthesiology, experienced nursing units, and the help and advice of consultants, especially otolaryngologists. The surgical approach should be meticulously planned. No irreversible maneuvers should be performed until one establishes certainty to proceed to resection. The surgeon should not attempt to exceed the limits of what appears to be reasonably possible. It must be remembered that a permanent tracheal T-tube might be the best solution for a patient with extensive tracheal damage that would defy reconstruction.