Carinal reconstruction: techniques and problems.

Techniques are available to allow resection of varying amounts of the carina and pulmonary parenchyma with appropriate primary reconstruction. Each patient required thorough evaluation beforehand. Because of the complexities of airway management involved, there must be close coordination between surgeon and anesthesiologist. Technical problems are predominantly related to excessive anastomotic tension and devascularization. Surgeons must have extensive knowledge of the extent of resection possible and the various release maneuvers possible to reduce anastomotic tension. Care must be taken to avoid devascularization of the divided ends of the bronchus. Postoperative care is demanding. The most feared complication is postoperative adult respiratory distress syndrome. Anastomotic complications are often life-threatening. Management needs to be individualized.