Page 123 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

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b a b a
(a) b a (b)

(c) (d)
Tracheal resection. (a) The cartilage rings can be split (line a) in large dogs. In small dogs and cats, the cut in the trachea is most easily made
8.17 between rings (line b). (b) Whenever possible, the endotracheal tube should be advanced beyond the site of tracheal excision. If this is not
possible the e cision should be planned and the distal tracheal incision made first. c sterile endotracheal tube should be available to secure the
air ay in the distal tracheal segment. tay sutures ill help to control the air ay. The orotracheal tube should be left in situ and will be used once the
anastomosis is complete. d henever possible the endotracheal tube should be advanced beyond the site of tracheal e cision. tay sutures ill help to
maintain temporary tracheal alignment whilst sutures are preplaced.

(a) (b)

(c) (d)
a hen suturing the trachea simple interrupted sutures are first preplaced in the dorsal tracheal membrane. b utures are preplaced
8.18 around the tracheal rings. If the tracheal rings have been split, the sutures appose the cut cartilage edges. Tension-relieving sutures can be
placed around the tracheal cartilages proximal and distal to the anastomosis site. (c) In small dogs and cats, sutures are placed around the tracheal rings,
which, when tied, appose the tracheal membrane between rings. Care should be taken not to tighten these sutures such that cartilage rings overlap
excessively. (d) Tension-relieving sutures can be placed around tracheal cartilages proximal and distal to the anastomosis site.

sutures are not tied first because the dorsal tracheal liga- et al., 2006). However, a simple continuous suture pattern is
ment is weaker and sutures may pull through (see Figure reported to result in a less precise apposition of the tracheal
8.16d). Various different suture patterns are described for segments (Fingland et al., 1995) and should be avoided in
performing the anastomosis: simple interrupted sutures, growing animals owing to the potential to increase the risk
simple continuous and simple interrupted reinforced with of stenosis during growth (McKeown et al., 1991).
horizontal mattress sutures. Sutures are placed to encircle Postoperative complications include subcutaneous
each cartilage ring adjacent to the transection site. A bio- emphysema due to air leakage, infection, decreased muco-
mechanical study in cadaveric canine tracheas suggests ciliary clearance and stenosis. Strict rest is required for at
that a simple continuous technique should be selected least 2 weeks following surgery to allow satisfactory heal-
when tension-relieving sutures are required for tracheal ing, and a harness should be used instead of a neck collar.
anastomosis. This offers the same advantages as simple Stenosis may be managed by bougienage; however, place-
interrupted reinforced with horizontal mattress sutures, but ment of an intraluminal stent (Culp et al., 2007) or surgical
is superior to simple interrupted sutures alone (Demetriou revision of the anastomosis may be required.

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