Reconstruction of the Cervical Trachea Using a Prefabricated Corticoperiosteal Flap From the Femur

Abstract

We treated a severe cervical fistula with a defect of tracheal cartilage using prefabrication of a corticoperiosteal flap combined with a cutaneous flap.The patient was a 16-year-old male with a cervical tracheal fistula that developed after a tracheostomy. Almost all the circumference of the trachea just below the cricoid cartilage up to the 4th tracheal cartilage had been lost.The reconstruction was performed in 2 series of operations as follows; repair of tracheal framework using a prefabricated corticoperiosteal flap, which was harvested from the femur and composed of a saphenous flap, and then complete closure using a local hinge flap and a free auricular cartilage graft. A free corticoperiosteal flap composed of a saphenous flap was transferred to the site just lateral to the defect. The corticoperiosteal flap, which has a flat shape, was bent in a reverse U-shaped semitubular fashion and the mucosal grafts were used to cover its inner surface. Two months later, the prefabricated corticoperiosteal flap and the saphenous flap were transposed leaving a part of the fistula as a tracheostoma. The remaining tracheostoma was closed secondarily. A satisfactory and stable result was obtained over an 8-year follow-up period.We believe that the procedure demonstrated here should be considered as a choice for the stable reconstruction of a cervical trachea.

Defect classification and reconstruction algorithm for patients with tracheostomy using the tunneled supraclavicular artery island flap

“…Including a vascularized bone chip introduces a new approach to total or partial closure of tracheocutaneous fistulas after tracheostomy or tumor surgery. While many authors address the multilayered structure of the defect [13], only one report on free vascularized bone transfer was found [8]. The concept of a regional myo-osteous flap of the neck was described by the myo-osteous sternocleidohyoideous flap for mandibular reconstruction in a review article by Kierner et al [9].…”

“…Also, the final aesthetic result is of great importance because of the visibility of the suprasternal notch. Several procedures have been advocated for closure, including multilayered advancement flaps [7,13], sternocleidomastoid muscle flaps [9], free cartilage transfer [17,2], and free flap surgery [8,3].…”

Anatomy of the Vascularized Lateral Femoral Condyle Flap

“…4,12,41,42 Our group demonstrated that this flap is also useful in the reconstruction of a perforated trachea, which has been shown in a recently published case. 43 Aside from many advantages of the medial femur condyle flap, including its low donor-site morbidity, the use of this technique is limited. The limitation is, in part, attributable to the wide anatomical variation of the descending genicular artery, which has been observed in anatomical studies focusing on the medial descending genicular artery.…”

Integra Acellular Collagen as a Vascular Carrier for Skin Flap Prefabrication in Rats

“…Since then, prefabricated free flaps have been investigated by different authors. [21][22][23][24][25] Although neovascularization is a natural and indispensable part of wound healing and can be selectively combined with vascular implantation and microsurgical techniques to create customized neovascularized free flaps, 26 flap prefabrication techniques still need further investigation as a result of the fact that the precise mechanisms of neovascularization are not well understood yet. 27 The survival of prefabricated flaps mostly depends on the status of angiogenesis in the prefabricated flaps through vascular induction.…”