Rylee

Rylee had her bronchoscopy today at CMH. We arrived there at 9:00 a.m. and they had her in surgery at about 10:45 a.m. There isn't much change with the swelling of her airway so they are going to have to do some reconstructive surgery in order to get her trach removed. The doctor isn't too sure how much surgery she will need so we won't know all the details until they get in and start the surgery. They will take some of her rib cartilage and place it in her airway to help open it up. I will post the official definition of this procedure at the end of the post if you want to read more on it. The doctor said she would be in the hospital for a couple weeks and one of the biggest problems will be getting her off the pain and sedation medications. She will have a pretty big withdrawl after they stop sedating her. I am going to have to get myself ready for this big surgery. The doctor did let us know that this is a very serious surgery and they will have the operating room all day and it should take about four hours. We just need to keep her healthy so we can get this surgery scheduled for May. They are unable to schedule the surgery now because they put some medication around her scar tissue to keep it from getting worse. This has to be on here for a few months or it could cause some problems during surgery if it isn't healed enough. Rylee was a true champ today! I kept telling all the nurses and doctors to expect her to be very upset after her surgery and that she would probably need her mommy right away. That wasn't the case today. She didn't need much oxygen and came out of the initial recovery room very quickly and we went up to the recovery room and cuddled for a couple hours. The nurses made several comments that she is a very active girl and hard to keep still. I know Rylee will do fine with this surgery, but it is still going to take some time to get prepared mentally for this. We are looking forward to being trach free this summer so we will do anything to get there. Thanks for all the prayers for our little angel today. Jordan had a lonely day at home with her nanny and she was very happy to see us get home. 

The LTP Procedure in More Detail

A LTP is now considered the mainstay for the treatment of severe subglottic and tracheal stenosis.  Cartilage is harvested from the sixth to eighth rib.  The cartilage is shaped and then sewn into the cartilage edges of the tracheal incision (figure 2).  This opens the airway substantially to allow greater allow flow.  For severe lesions, in addition to an anterior (front) graft, a posterior (back) graft of cartilage can be sewn into place.  As this is the patient's own tissue, the rib cartilage grows as the patient and trachea grow.
 
The initial procedure may include decannulation (removal of tracheotomy tube).  If this is planned, the patient remains intubated with an endotracheal tube, ventilated by a respirator and sedated for several days.  This allows time for the graft to strengthen and heal.  Extubation (removal of the endotracheal tube) will follow.  This sometimes requires a follow up visit to the operating room.
 
If the LTP does not include decannulation initially, a tracheal stent is inserted to support the graft.  This stent is made of silastic, which is flexible and open.  The stent is modified in order to accommodate the placement of the patient's tracheotomy tube in front and below it (Figure 3).  The patient may be ventilated through the tracheotomy tube postoperatively for a few days.  This LTP approach includes stent removal and possible decannulation 6-8 weeks after the initial procedure.