Reconstruction of the (Crico)trachea for malignancy in the virgin and irradiated neck

Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses

“…The former patient recovered without any further problems, whereas the latter 2 required permanent tracheotomy in 1 case and total laryngectomy with radial forearm free flap reconstruction in the other. A more conservative approach therefore seems prudent in the case of previous RT, as also observed by Ch'ng et al, 30 suggesting that 4 tracheal rings (around 2 cm) is the maximum limit for segmental resection and primary anastomosis. These authors also recommend covering the surgical field by using local or free flaps to have external anastomosis reinforcement, thus preventing airway dehiscences and fatal bleeding due to innominate artery erosion.…”

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).…”

“…A small window defect in the trachea after tumor resection is usually closed primarily, or reinforced with surrounding soft tissue or a patch with adjacent strap muscle or sternocleidomastoid muscle (Friedman, Toriumi, Owens,& Grybauskas, 1988;Friedman & Mayer, 1992;McCaffrey, 2006). Other nonvascularized grafts such as fascia lata, pericardium, periosteum, bone strips with fibrocollagen, periosteal patch applied to staggered buccal mucosa and auricular cartilage, rib and ear perichondrium, nasal septal mucocartilage, epidermis, and bronchial and tracheal patches can also be used to manage small defects successfully (Bryant, 1964;Ch'ng et al, 2012;Cohen et al, 1986;Delaere, Liu, & Hermans, 1998;Drettner & Lindholm, 1970;Fonkalsrud & Plested, 1966;Idriss et al, 1984;Kucera, Doss, Dunn, Clemson, & Zwischenberger, 2007;Paulson, 1951aPaulson, ,1951b (Al-Khudari et al, 2013;Ch'ng et al, 2012;Fujiwara et al, 2005;Hamahata et al, 2017;Yu et al, 2006Yu et al, , 2011 and secondary reconstructions (Detwiller et al, 2013;Ebihara et al, 2011;Fukunaga et al, 2014;Fujiwara et al, 2009;Homma et al, 2003;Koshima et al, 1997;Kashiwa et al, 2009;Ninkovic et al, 2016;Teng et al, 2005).…”

“…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, 2011;Yu et al, 2006Yu et al, , 2011 rib cartilage, (Ch'ng et al, 2012;Ebihara et al, 2011;Fukunaga et al, 2014;Fujiwara et al, 2009;Hamahata et al, 2017;Teng et al, 2005) shown to resorb and cause airway collapse (Anderl & Haid, 2005;Yu et al, 2011), we use bone grafts in most cases (rib cartilage was used in one case). Cartilage is also fragile and subject to calcification in adults.…”