Osteocutaneous radial forearm reconstruction of large partial cricotracheal defects

Abstract

This is the first reported case of malignant immature teratoma to involve the larynx, trachea, and recurrent laryngeal nerve in an adult patient, and the first single-stage technique described to use free tissue transfer without prefabrication for a 7-cm airway defect.

Immediate tracheal reconstruction with forearm flap and bone graft

“…(McCaffrey, ) However, reconstruction is challenging for large defects, especially those covering more than one‐half of the tracheal circumference. Several procedures have been reported for the reconstruction of large tracheal window defects, (Al‐Khudari, Sharma, Young, Stapp, & Ghanem, ; Ch'ng et al, ; Detwiller, Schindler, Schneider, & Lindau, ; Ebihara et al, ; Fujiwara, Maeda, Kuwae, Nakagawa, Nakao, ; Fukunaga et al, ; Fujiwara, Nishino, & Numajiri, ; Hamahata, Beppu, Yamaki, & Sakurai, ; Homma et al, ; Koshima, Umeda, Moriguchi, Handa, Akisada, & Orita, ; Kashiwa et al, ; Ninkovic, Buerger, Ehrl, & Dornseifer, ; Teng, Malkin, & Urken, ; Yu, Clayman, & Walsh, , ) including immediate(Al‐Khudari et al, ; Ch'ng et al, ; Fujiwara et al, ; Hamahata et al, ; Yu et al, , ) and secondary reconstructions (Detwiller et al, ; Ebihara et al, ; Fukunaga et al, ; Fujiwara et al, ; Homma et al, ; Koshima et al, ; Kashiwa et al, ; Ninkovic et al, ; Teng et al, ).…”

“…In our procedure, a vascularized radial forearm flap is transferred simultaneously at the time of tumor resection. To achieve the rigidity of the reconstructed trachea, artificial materials (e.g., polyester, polytetrafluoroethylene mesh, polyethylene, titanium mesh, and hydroxyapatite), (Ebihara et al, ; Yu et al, , ) rib cartilage, (Ch'ng et al, ; Ebihara et al, ; Fukunaga et al, ; Fujiwara et al, ; Hamahata et al, ; Teng et al, ) auricular cartilage, (Fujiwara et al, ; Koshima et al, ; Detwiller et al, ) clavicle, (Homma et al, ) radius, (Al‐Khudari et al, ), and femur (Kashiwa et al, ; Ninkovic et al, ) are used to prevent tracheal collapse during respiration. Since cartilage has been shown to resorb and cause airway collapse (Anderl & Haid, ; Yu et al, ), we use bone grafts in most cases (rib cartilage was used in one case).…”

Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction

“…The rigid yet low profile bone offered by the osteocutaneous RFFF allows for increased versatility and malleability in areas of complex recipient site architecture. For example, the bone in the osteocutaneous RFFF is well suited for reconstruction of the orbital rim, nasal bridge, nasoorbitoethmoid complex, anterior maxilla, and the cricotracheal area . The osseous component of other flaps may be too bulky for these reconstructions.…”

One‐stage reconstruction of tracheal defects with the medial femoral condyle corticoperiosteal‐cutaneous free flap

“…In the literature, different techniques were applied experimentally for tracheal reconstruction . For clinical use, previous reports included different types of local and free flaps as well as prefabrication methods for reconstruction of tracheal defects . For building the framework of the trachea, different artificial, autologous, and allogeneic materials were used .…”