Traumatic and iatrogenic lesions of the trachea and bronchi.

Objective: The traumatic lesions of the trachea and the main bronchi appear to be rare, but as complications of the severe chest and neck injuries they require urgent surgical treatment. Unfortunately for the last few years the incidence of such traumas has increased.

Methods: During the last 15 years we have treated 28 patients (20 male and eight female) with traumatic lesions of the tracheobronchial tree aged from 8 to 64 years. The tracheal lesions were predominantly iatrogenic caused by difficult endotracheal intubation. The lesions of the bronchi (12 of the main and three of the lobar) were caused mainly by blunt traumas (car accidents and falling from heights). Total disruption of the right main bronchus was observed in five cases and of the left main bronchus - in seven cases. Emergency operative treatment was performed in all patients within 6 to 12 h after the incident. Cervical approach was performed in eight patients and postero-lateral thoracotomy in the other cases.

Results: We had one death in the early post, which was due to a severe trauma. Excellent and good results were obtained in 27 patients, which recovered well within 3 months and were followed up for periods ranging from 1 to 10 years.

Conclusion: The traumatic lesions of the trachea and main bronchi require emergency surgical treatment. The proper choice of operative approach is largely dependent on the precise early diagnosis and on the determining of the exact location of the lesions. Operative tactics must aim at optimal preservation of the functional lung parenchyma and have to include reconstructive and plastic procedures.