Background Acute posttraumatic tracheobronchiallesions are rare events associated with significant morbidityand mortality. They are caused by blunt and penetratingtrauma, or they are iatrogenic, appearing after intubation ortracheotomy. Although surgery has traditionally beenconsidered the treatment of choice for these injuries, recentreports show that conservative treatment can be effective inselected patients. The aim of this study was to evaluate therole of surgical and conservative management of theselesions, differentiated on the basis of clinical and endoscopiccriteria.Methods From January 1993 to October 2010, a total of50 patients with acute posttraumatic tracheobronchiallesions were referred for treatment to our department. Inall, 36 patients had iatrogenic injuries of the airway, and 14had lesions resulting from blunt or penetrating trauma.Results Of the 30 patients who underwent surgery, thelesion was repaired with interrupted absorbable sutures in29; the remaining patient, with an associated tracheoesophagealfistula, underwent single-stage tracheal resectionand reconstruction and closure of the fistula. In all, 20patients were treated conservatively: clinical observation in5 patients, airway decompression wit a mini-tracheotomycannula in 4 spontaneously breathing patients, andtracheotomy with the cuff positioned distal to the lesion in11 mechanically ventilated patients. One surgical and oneconservatively-managed patient died after treatment (4%overall mortality). Complete recovery and healing wereachieved in all the remaining patients.Conclusions Surgery remains the treatment of choice forposttraumatic lesions of the airway. However, conservativetreatment based on strict clinical and endoscopic criteria-stable vital signs; effective ventilation; no esophagealinjuries, signs of sepsis, or evidence of major communicationwith the mediastinal space-enables favorable results to be achieved in selected patients.
ASJC Scopus subject areas