The fate of the skin graft in laryngoplasty.

In laryngoplasty procedures, laryngotracheal soft tissue defects are often repaired using skin grafts. While stenting is necessary to approximate and immobilize the graft, prolonged stenting causes increased bacterial counts, granulation tissue formation, tissue ischemia, and graft failure. Optimal time for stent removal has not been experimentally defined. Using the ferret animal model, 24 laryngoplasty procedures were performed. The subjects were stented by group for 0, 3, 7, 14, or 28 days. Analysis consisted of quantitative bacteriology, dye perfusion, and quantitative histologic assessment of graft viability. Tissue culture results revealed that by 3 days after the procedure all groups had 10(5) CFU of bacteria per gram of tissue. Graft viability in successful procedures was maximal in the 7-day group and statistically significant from the 3-day to the 28-day groups. In conclusion, while stenting is necessary for graft adherence, prolonged exposure to local tissue sepsis leads to progressive graft destruction.