Rib Cartilage Harvest for Laryngotracheal Reconstruction

Video Type: CVideo
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Author: Michael Yim
Published:
Specialties: Otolaryngology, Pediatric Surgery
Schools: Baylor College of Medicine
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Basic Info

Contributors: Deepak Mehta

This video depicts how to harvest a rib cartilage graft for use in pediatric laryngotracheal reconstruction for airway stenosis.

DOI# http://dx.doi.org/10.17797/oo77838cxt

Authors Recruited By: Deepak Metha

Advanced

Procedure

Harvest of rib cartilage graft for use in pediatric laryngotracheal reconstruction

Indications

When an anterior or posterior cartilage graft is needed to reconstruct a pediatric airway with subglottic stenosis. This is a much more robust cartilage graft compared to thyroid ala, septal, or auricular cartilage as these do not typically provide enough structural support.

Contraindications

Instrumentation

Setup

The harvest of this graft must be performed in a sterile environment with separate surgical equipment used instead of using the same equipment that was used for the neck to avoid cross-contamination

Preoperative Workup

See laryngotracheal reconstruction video

Anatomy and Landmarks

The incision is typically made in the inframammary crease and dissection taken down to perichondrium of the rib. The costochondral junction is located utilizing a needle. Periosteum is preserved on one side of the graft during the harvest. The length of graft required is pre-determined by measurements of the airway prior to starting the cartilage harvest.

Advantages/Disadvantages

Stronger than auricular, thyroid ala, or septal cartilage, and is thus considered the 'workhorse' cartilage graft for airway reconstruction. Disadvantage is that it requires a separate surgical field and dissection adding to the length of the surgery.

Complications/Risks

Care must be taken to avoid violating the pleural space during dissection as this could potentially lead to a pneumothorax.

Disclosure of Conflicts

Care must be taken to avoid violating the pleural space during dissection as this could potentially lead to a pneumothorax.

Acknowledgements

References

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