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eComment: Autologous or bovine pericardial patch for the repair of membranous tracheal wall lacerations?

Aristotle University of Thessaloniki Medical School, AHEPA University Hospital, Department of Cardiothoracic Surgery, 1 Stilponos Kiriakidi Street, 54636 Thessaloniki, Greece

Tracheal laceration following double-lumen intubation during Ivor Lewis esophagogastrectomy

Barbetakis et al. [1] describe the successful repair of an iatrogenic tracheal laceration that was the complication of a double-lumen endotracheal tube insertion to perform an Ivor-Lewis esophagogastrectomy. A bovine pericardium patch reinforced by the gastric conduit was used to cover the tracheal laceration, after failure of their initial attempt to directly close the membranous wall with interrupted sutures.

Bovine pericardium as a tracheal patch was also used to repair a membranous tracheal wall laceration by Knott et al. [2] and the authors experienced extrusion of the patch within the tracheal lumen four months after the operation that had resulted in acute airway obstruction.

Bovine pericardial strips have been used to reinforce the stapling line and to seal air leaks from the emphysematous lung tissue during lung volume reduction surgery (LVRS). Bovine pericardial strips used during LVRS were well documented in the past to cause late complications with migration of the strips into the bronchial lumen [3]. Bovine pericardium is considered to elicit an inflammatory reaction, which may be responsible for the erosion of the bronchial wall and migration [3].

Successful autologous pericardial patch repair of iatrogenic membranous tracheal wall lacerations have been reported in the past, with or without reinforcement of the repair with pedicled thoracic muscles [4, 5]. The pericardial patch is completely covered by the tracheal epithelium within a reasonable time period, it does not cause inflammatory reactions, is not rejected, and therefore, it consists of a more reliable tracheal substitute than the bovine pericardium [4, 5]. Indeed, possible pericardial inflammation secondary to induction radiotherapy might preclude the use of autologous pericardium for the repair of the membranous tracheal wall tear in the reported case.

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1. Barbetakis N, Samanidis G, Paliouras D, Tsilikas C. Tracheal laceration following double-lumen intubation during Ivor Lewis esophagogastrectomy. Interact CardioVasc Thorac Surg 2008;7:866–868.[Abstract/Free Full Text]
2. Knott DP, Lorenz RR, Eliachar I, Murthy SC. Reconstruction of a tracheobronchial tree disruption with bovine pericardium. Interact CardioVasc Thorac Surg 2004;3:554–556.[Abstract/Free Full Text]
3. Provencher S, Deslauriers J. Late complication of bovine pericardium patches used for lung volume reduction surgery. Eur J Cardiothorac Surg 2003;23:1059–1061.[Abstract/Free Full Text]
4. Foroulis CN, Simeoforidou M, Michaloudis D, Hatzitheophilou K. Pericardial patch repair of an extensive longitudinal iatrogenic rupture ofthe intrathoracic membranous trachea. Interact CardioVasc Thorac Surg 2003;2:595–597.[Abstract/Free Full Text]
5. Gorenstein LA, Abel JG, Patterson GA. Pericardial repair of a tracheal laceration during transhiatal esophagectomy. Ann Thorac Surg 1992;54:784–786.[Abstract]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Google Scholar Articles by Foroulis, C. N. PubMed PubMed Citation Articles by Foroulis, C. N. Related Collections Related Article