A stich in time breathes life into youth

 

A CASE OF COMPLETE TRACHEAL TRANSECTION:
MANAGED SURGICALLY



A 22-Year old boy had an accident and suffered complete Tracheal Transection with facial, clavicle and bilateral multiple rib fractures. Due to low saturation, he had an emergency intubation. His saturation was still low and a bronchoscopy at the referring hospital revealed complete tracheal transection. Somehow, with intubation his saturation stabilised at 80% and 12 hrs after the injury, he was airlifted to our hospital on ventilator with saturation around 80% on FIO2 100. The Bronchoscopy confirmed complete tracheal transection with two ends lying many centimetres apart, but connected by a tissue tunnel which had formed a pseudo-passage through which the ventilation to Lungs was maintained.

He was immediately operated and after 6 hrs of a technically demanding surgery, an end to end anastomosis of the transected trachea was performed. He also had multiple lacerations and hematoma in the Right Lung which was managed by repair. He had a slow post-operative recovery, due to his Right Lung Hematoma and associated severe maxillo-facial injuries. However, He was weaned of ventilator on 7th Day, shifted out of ICU on 14th Day and discharged on 28th day after appropriate management of associated injuries. He has since returned to normal life.

Complete Tracheal Transection is a rare injury, often fatal because of complete loss of ventilation. However, occasional patients where ventilation into the distal segment can still be maintained by bronchoscopic guided cannulation of the distal trachea or some connecting tissue maintaining the continuity (like in our case), can reach hospital alive but need emergent thoracotomy and end to end anastomosis of the trachea.

Such severe tracheal injuries are usually fatal and many patients never make it to the hospital. Successful management requires emergent evacuation of the injured to a trauma care centre for stabilisation (Secure A, B, C) and a quick, safe and efficient transfer to a centre where definitive surgical management (tracheal reconstruction in this case) can be undertaken at the earliest.

This rare case exemplifies the successful management of airway trauma where each step was carried out in the recommended manner leading to a successful outcome.

                 
tracheal injury tracheal injuries in windpipe complicated tracheal surgery

Intra Operative View :
during suturing

Newspaper clipping :


Times of India / 22 May 2015
Stitch in time breathes life into youth

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