Securing stent during multi-stage laryngotracheoplasty-An evolved technique

Background: Multi-stage laryngotracheoplasty (LTP) typically requires a stent be secured to the airway for 2-6 weeks. Our technique has evolved over time to securing the stent to the strap muscles and tying a series of knots long enough to leave the suture tail protruding through the skin incision, which simplifies stent removal. Methods: Retrospective chart review. Results: Twenty-four patients underwent multi-stage LTP at our institution from 2007 to 2013. Eight patients were excluded from the study because they either did not have a stent placed (n= 4), or they had a t-tube placed which was not sutured in place (n= 4). Of the remaining 16 patients, 62.5% (n= 10) had their stent secured via sutures which were buried below the skin, and 37.5% (n= 6) via a long suture tail which was left protruding through the end of the skin incision. An incision was required for stent removal 100% of buried sutures patients, and 33% of exposed suture patients (p= 0.0009). Average operative time for stent removal was 60. min in the buried sutures group, and 25. min in the exposed sutures group (p= 0.0075). Conclusions: Securing stents via an exposed suture technique decreases the need for making a skin incision during the second stage of the operation, and significantly decreases the operative time of the second stage.