An experimental model to investigate initial tracheal anastomosis strength

Authors

  • Peter N. Schilt MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
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  • Bryan R. McRae MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
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  • Ozan Akkus PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
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  • Susan R. Cordes MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
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  • Stacey L. Halum MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
    • Department of Otolaryngology–Head and Neck Surgery, Indiana University, 702 Barnhill Dr., Suite #860, Indianapolis, IN 46202
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Early anastomotic dehiscence is a devastating complication of segmental tracheal resection. Although wound healing, patient comorbidities, and anastomotic tension are all influential factors, there is a paucity of information available on initial tracheal stability after various tracheal anastomosis techniques in human tissue.

Study Design:

Prospective cadaver study.

Methods:

We present a novel, inexpensive pulley-based system to apply symmetric tension on the trachea in a longitudinal direction to the point of anastomotic dehiscence. The validity of this mechanism was confirmed with trials using incrementally increasing quantities of the same suture type. Twenty-four trials were then performed on 12 cadaver tracheas (six fresh and six preserved) to compare anastomotic strength with two commonly used suture materials (3-0 polyglactin [Vicryl] vs. 3-0 polydioxanone [PDS]).

Results:

Validation studies demonstrated that the force increased appropriately with an increasing number of sutures tested. In the tracheal anastomoses, tracheal suture pull-through was the most common mechanism of dehiscence, regardless of suture type. No significant difference in anastomotic stability was detected between the fresh versus preserved cadaver tracheas. The mean anastomotic strength was slightly greater for Vicryl (179.9 N) when compared to PDS (161.5 N), but the difference did not reach significance (P = .207).

Conclusions:

We introduce an inexpensive tool for measuring initial tracheal anastomosis stability with human cadavers, which demonstrated no difference in the tracheal pull-through strength of Vicryl and PDS.

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