[Application of autocartilage for treatment of tracheostenosis with chondromalacia].

Reconstruction of the stenotic part of the trachea with chondromalacia was made with semicircular autocartilage. The operation included two stages: creation of a semiring of rib autocartilage in abdominal tissues (stage I), implantation of the semiring to tracheal walls (stage II). Reception of the autocartilage was confirmed morphologically. According to 5 year follow-up, a stable positive result was obtained in 14 of 18 patients.

[Experience in repair of cervical trachea frame with semirings made of rib autocartilage].

The method of the repair of a tracheal cervical portion with application of semirings formed of rib autocartilage has been developed and used in 18 patients. In 17 patients semirings were made from whole or joint 2-3 short cartilaginous plates, in 1 patient it was made of bone-cartilaginous rib fragment. In the latter case the bone part of the semiring was not sufficiently rigid because of bone decalcination. In one case the semirings were destroyed by suppuration. One patient had tracheal restenosis after implantation of the semirings into the tissues adjacent to the trachea. In the rest 15 cases all the treatment stages were completed successfully -- the implanted semirings provided adequate regidity, natural breathing recovered. The author believes that success of the treatment was achieved due to good engraftment of the implant and arch structure of the tracheal frame which is optimal.

[Surgical strategies in persistent stenosis of cervical trachea]. / Khirurgicheskaia taktika pri stoikikh stenozakh sheinogo otdela trakhei.

Two methods of surgical treatment optimization can be used in patients with persistent stenosis of cervical trachea: 1) reconstruction of tracheal cartilaginous frame by means of insertion of the rings made of the rib autocartilage in the tissues adjacent to trachea, 2) hydromassage (pulsating change in the latex balloon serving as a stent which is placed in the trachea after its surgical recanalization). Hydromassage shortens duration of tracheal epithelization to 2-3 months. Positive results achieved with the above methods allow the authors to recommend them into wide clinical practice.

[Hydromassage of wound surface of surgically reconstructed laryngeal lumen and upper trachea]. / "Gidromassazh" ranevoi poverkhnosti vosstanavlivaemogo khirurgichskim putem prosveta gortani i verkhnei chasti trakhei.

In surgical reconstruction of laryngostenosis and stenosis of the upper trachea after dissection of the scars we place laryngotracheal prosthesis (LTP) in the created lumen for a year and longer. The LTP dilator prevents regrowing the scars into the larynx and trachea until termination of the wound epithelization. The author has designed a device which provides a pulsed change in the pressure of water-filled latex balloon-dilator of the LTP. This pulsed work is realized by 7-8-s sucking out water and filling again of 1/3 of water volume in the dilator. Such procedures lasting for 20-30 min conducted 2 times a day are called hydromassage of the larynx and trachea. In 7 patients subjected to hydromassage for a full time of wearing the LTP, epithelization of the wound surface of the reconstructed part of the airways occurred within 2-2.5 months. If hydromassage was performed for half the time of LTP wearing (12 patients) epithelization occurred within 3-3.5 months.

[Results of laryngeal and tracheal patency restoration in chronic stenosis]. / K otsenke rezul'tatov khirurgicheskogo lecheniia po vosstanovleniiu prosveta gortani pri ikh khronicheskikh stenozakh.

The paper reports treatment of tracheostenosis using a surgico-dilatation method. The laryngotracheal prostheses were adjusted to each patient anatomy. Hydromassage of the wound surface of the repaired part of the respiratory tract has been practiced since 1997. Five patients with lysis of the tracheal rings the cartilagious frame of the trachea was reestablished with rings created of rib autocartilage. Positive results were obtained in 74 of 81 patients (88.8%).

[Restoring the tracheal lumen in the scar closure of its upper part by lysing of the cartilaginous frame]. / Vosstanovlenie prosveta trakhei pri rubtsovom zarashchenii verkhnego ee otdela, soprovozhdaiushchemsia lizirovaniem khrashchevogo karkasa.

Reestablishment of the tracheal lumen in its scarring is described. External approach is used to dissect scars in the trachea. The laryngotracheal prosthesis (water-filled cylindric latex balloon fixed to the tracheotomy tube) is placed in the lumen until epithelized (at least for 4 months). The plates 10 mm in size are cut off the rib auto-cartilage, formed as a ring and fixed on the teflon coils which are inserted in the tissues of the anterior abdominal wall for a month. Thus, the plates acquire a stable semi-ring form. Without removal of the laryngotracheal prosthesis, the semi-rings are implanted into the tissues around the upper tracheal part. The laryngotracheal prosthesis is removed 1 month after this. The trachea was reconstructed in 3 patients by this procedure. All of them resumed normal natural breathing.

[Stimulation of the growth of cicatricial tympanic membranes]. / O stimuliatsii rosta rubtsovykh timpanal'nykh membran.

The growth of cicatricial tympanic membranes starts with the formation of a granulation stricture which gradually transforms into a membrane. For the cases when granulation does not lead to the formation of a membrane or when the membrane growth is too slow, the present author developed a method of immuring a foreign body - a silk thread - into the granulation layer for as long as 6 to 8 days. The foreign body stimulated granulation in the area of its localization. The method was used for the treatment of 16 patients: in 4 of them granulation did not tend to the membrane formation and in 12 patients the growth of the granulation stricture, once it reached a certain size, became very slow or terminated. Due to stimulation according to the above method, a cicatricial tympanic membrane of a normal size grew in 11 patients. In 3 other patients the well grown membrane was removed because of suppuration in the tympanic cavity. In 2 remaining patients no signs of membrane growth were seen in spite of stimulation.