EDITORIAL

Tracheal Blood Supply

Hermes C. Grillo, M.D. Surgeons are aware of the debts their science and craft owe to the basic sciences. Developments in surgery also make demands for basic information that is not yet available or is at best incomplete. In response, new data must be developed or older information refined. The work of Boyden and associates [l], in providing detailed descriptions of the segmental anatomy of the lung, its bronchi, and the pulmonary vessels, was done in response to Wangensteens request for a seminar on the anatomy of segmental pneumonectomy following Churchill and Belseys [21 demonstration of the reality of this concept. When the possibilities of extended tracheal resection with reconstruction by primary anastomosis were reinvestigated, it became clear that mobilization techniques must take into account the delicate vascular anatomy of the trachea. General information was available in anatomical textbooks, but the need for precise definition had not existed. This need occasioned the initial injection studies by Miura and Grillo [ 3 ] , who explored the arterial blood supply of the upper trachea. Salassa, Pearson, and Payne (p 100, this issue) offer a detailed description of both the gross and microscopic vascular supply of the trachea. Using conventional techniques as well as clearing and microscopical dissection, they have provided us with an exhaustive description of this anatomy. The work is a classic and definitive study. Even in the ancient subject of gross
From the Department of Surgery, Massachusetts General Hospital, Boston, MA 02114

anatomy, contemporary needs may point out deficiencies in accumulated knowledge. The gap must be filled by scholarly and precise work such as this. This is not a wholly academic project by any means. One of the great technical pitfalls of extensive tracheal mobilization is destruction of the blood supply. The consequences may not be immediately obvious. The cartilaginous structure of the trachea will hold sutures for a prolonged period despite devascularization. A slow process of sloughing may occur, followed by stenosis which becomes evident only sometime after the attempted repair. I regret to say that in my clinical referral practice I have seen several examples of such surgical disaster which, I am certain, were the result of the original surgeons failure to understand or acknowledge this issue. Whereas prior observations of tracheal blood supply plus an empirical regard for preserving the supply have usually been sufficient to avoid this disaster, the current study from the Mayo Clinic provides us with the precision of information essential for surgeons working in this difficult area.

References
1. Boyden EA: Segmental Anatomy of the Lungs.

New York, McGraw-Hill, 1955

2. Churchill ED, Belsey R: Segmental pneumonec-

tomy in bronchiectasis: the lingula segment of left upper lobe. Ann Surg 109:481, 1939 3. Miura T, Grillo HC: The contribution of the inferior thyroid artery to the blood supply of the human trachea. Surg Gynecol Obstet 123:99, 1966