Long‐term outcomes of microsurgical reconstruction for large tracheal defects

Abstract

BACKGROUND: Reconstruction of large tracheal defects has been largely unsuccessful. The purpose of this study was to review the authors' experience with microsurgical reconstruction of these defects. METHODS: Seven cases of microsurgical tracheal reconstruction were performed between May 2002 and April 2008. All but 1 patient had recurrent thyroid cancer; the other patient had primary adenocystic carcinoma of the trachea. The radial forearm free flap was used for lining in all cases. Rigid support was provided with a variety of prosthetic materials. RESULTS: All defects involved the cervical trachea, with an average length of 5.8 cm ± 1.0 cm (range, 5 cm‐7.5 cm). The width of defects ranged from half of the tracheal circumference to the entire circumference. Major complications included air leak in 4 patients, exposure and removal of prosthesis in 2 patients, and cardiopulmonary complications in 2 patients. One patient with postoperative retroperitoneal hematoma, abdominal compartment syndrome, and multiple organ failure died 2 months after surgery. Two patients died of other causes 1 year and 4 years, respectively, after surgery. The other 4 patients were alive and disease free, with follow‐up ranging from 1 to 4.5 years. Four patients are asymptomatic, with normal speech and swallowing functions. Two patients remained tracheostomy dependent, but vocal ability was intact. All patients tolerated a regular diet. CONCLUSIONS: Microsurgical reconstruction is a viable option in selected patients with large cervical tracheal defects that are beyond primary repair. Cancer 2011. © 2010 American Cancer Society.

The prefabricated supraclavicular artery flap in high‐risk tracheal stenosis patients

“…Yu et al reconstructed seven large tracheal defects from ablative procedures for malignancy. They used microsurgical reconstruction with radial forearm free flaps and various synthetic materials . Four patients were ultimately decannulated, but others had severe complications including exacerbation of medical comorbidities, with three patients developing synthetic material exposure.…”

Microsurgical reconstruction of combined tracheal and total esophageal defects

“…Rigid support is mandatory for tracheal reconstruction with an intact larynx. 20 These patients presented to us with a tracheo-(broncho-) esophageal fistula and life-threatening aspiration pneumonia with active disease. Obviously, the priority of management is to eliminate the fistula, secure the airway, and control mediastinal infection with a ''damage control'' lifesaving procedure.…”

6 Laryngotracheal Reconstruction with Prefabricated Free Flaps and Tracheal Allotransplantation

“…14 A cryopreserved or decellularized tracheal tube no longer has a viable mucosal lining, and a new one would need to be created with thin, vascularized skin flaps. 17 However, the functional outcome is unpredictable, since even a very thin skin flap is still much thicker than true mucosal lining and may obliterate the inner lumen. When a wider outer cartilage skeleton is made with cartilage grafts to avoid obstructing the inner lumen with a vascular free skin flap, it is very difficult to predictably create an optimal tubular and flexible shape.…”