Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

Abstract

Background Large or complex trachea defects often require some tissue to reconstruct, various flaps have been reported for reconstructing this defect. However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction. Therefore, this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction. Methods Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed. Results All of the pedicled TAAP flaps in our study survived. The flap size ranged from 2 cm × 5 cm to 4 cm × 10 cm, and the size of each island of one double-island flap was 2 cm × 2.5 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities, such as diabetes, hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis. Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment. Conclusion Pedicled TAAP flaps provide a short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

Pedicled flaps reconstruction of hypopharynx and laryngeal defects: Successful preservation of laryngeal function in patients with advanced hypopharyngeal cancer

“…This approach effectively reduces the risk of postoperative complications within the recipient area during radiotherapy and contributes to expedited patient recovery times. [19][20][21][22] Second, in contrast to the combined repairs involving the sternocleidomastoid artery island flap and laryngeal mucosal flap or the laryngeal mucosal flap alone for laryngeal cavity reconstruction, our employment of the thoracoacromial artery perforator flap allows for the acquisition of a larger surface area. This advantage enables the repair of extensive defects, even those extending to the cricoid cartilage, ultimately creating a more capacious reconstructed laryngeal cavity, which greatly aids in achieving improved swallowing function.…”

“…Their fabrication is relatively straightforward, ensuring a stable blood supply without the necessity for intricate microvascular procedures or skin grafting. This approach effectively reduces the risk of postoperative complications within the recipient area during radiotherapy and contributes to expedited patient recovery times 19–22 . Second, in contrast to the combined repairs involving the sternocleidomastoid artery island flap and laryngeal mucosal flap or the laryngeal mucosal flap alone for laryngeal cavity reconstruction, our employment of the thoracoacromial artery perforator flap allows for the acquisition of a larger surface area.…”

Successful cervicothoracic esophageal stricture treatment with partial sternectomy and a pedicled TAAP flap: A case report

“…Other pedicled flaps such as the pectoralis major myocutaneous flap and the latissimus dorsi myocutaneous flap are too bulky to be used in reconstructing esophageal stenosis. A pedicled TAAP flap is a good choice with advantages of stable blood supply, simple harvest process, and lower donor-site complications compared with microvascular free flaps or colonic interposition (18). However, our technique has some limitations.…”

Versatility and outcomes of lateral arm free flap in head and neck reconstruction: a retrospective case series study of our experiences and innovations

“…Since its initial introduction in the early 1970s, free tissue transfer has gradually gained global recognition as a safe and durable procedure in head and neck surgery. 1 , 2 , 3 Among the various free flaps developed, the Lateral Arm Free Flap (LAFF) was first pioneered by Song et al in 1982 and further defined by Cormack and Katsaros in 1984. 4 , 5 , 6 The LAFF relies on the Posterior Radial Collateral Artery (PRCA) located along the posterior aspect of the arm, offering advantageous features such as variable thickness, minimal hair growth, and the ability to facilitate primary closure without necessitating a skin graft, thereby reducing donor site morbidity.…”