Peirong Yu1, Gary L Clayman, Garrett L Walsh. 1. Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. peirongyu@mdanderson.org
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.
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.
Authors: James J Daniero; Dale C Ekbom; Alexander Gelbard; Lee M Akst; Alexander T Hillel Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-06-01 Impact factor: 6.223