Surgical decision making in tracheobronchial injuries on the basis of clinical evidences and the injury's anatomical setting: a retrospective analysis.

BACKGROUND: Airway trauma is a life threatening condition requiring prompt diagnosis and management. We present our experience focusing on the diagnosis, airway management and treatment.
MATERIAL AND METHODS: This is a retrospective analysis of 25 patients treated for tracheal or bronchial injury within a 12 year period. Data collected included: mechanism and sites of injury, associated injuries, clinical presentation, indications for surgical management, treatment and outcome.
RESULTS: There were 15 traumatic injuries (blunt/penetrating, 10/5 patients) and 10 post-intubation perforations. The most common findings included subcutaneous emphysema, pneumomediastinum and pneumothorax. Endotracheal intubation was carried out under bronchoscopic guidance. Tracheostomy was performed in one patient. Most injuries were located at the trachea/carina. Surgical treatment was undertaken in 22 patients. In 13 of them, all with traumatic injuries, the surgical treatment was decided on the basis of the clinical and radiological findings. The decision for surgery in post-intubation injuries was based on the proximity of the injuries to the carina (2 patients), the suspicion of an unsafe airway (1 patient) and the present of posterior tracheal wall perforations>2 cm (2 patients). The surgical approach for the repair was dictated by the location of the injury. There was a single case of perioperative mortality in the subgroup of patients with traumatic injuries.
CONCLUSIONS: Surgical primary repair represents the treatment of choice in airway injuries with the approach depending on the specific site of the lesion. Therefore we consider valuable the division of the tracheobronchial tree in 4 zones.