Resurfacing of a Large Laryngeal Wound with Mucosa Grafting: A Combined Technique Using Endoscopic Suture and Laser Soldering

Abstract

Resurfacing of a large laryngeal wound has traditionally been accomplished via an open approach—transplanting free mucosa either onto the wound directly or upon a stent. This study proposes a new approach for wound resurfacing that combines endoscopic suturing with a laser welding technique. By means of a carbon dioxide (CO₂) laser, a large (20 × 25 mm) defect in laryngeal mucosa involving the glottic and subglottic area was created in five dogs. Two of the animals served as controls and received no further treatment. In the remaining three animals the wound was resurfaced with buccal mucosal grafts fixed in place by standard suture placement and a technique of CO₂ laser-assisted tissue soldering. The accessible edges of the graft were soldered endoscopically with human albumin-based tissue adhesive “activated” by low power (0.8 to 1.0 W) of a CO₂ laser. All animals were examined endoscopically 1 week after surgery and sacrificed painlessly 4 weeks after surgery. The treated animals showed a viable mucosal graft with improved wound healing and voice function compared to that of the control animals. This new approach combines suture fixation of the inferior aspect of the mucosal graft, an area not well exposed endoscopically, and endoscopic laser soldering techniques for the repair of large laryngeal wounds.