Tracheoplasty using titanium reconstructive plates with strap-muscle flap.

The reasons for unsuccessful decannulation after a laryngotracheoplasty may be multifactorial depending on the techniques used. Excessive granulation tissue may develop, necessitating further adjunctive procedures. Cartilaginous grafts may get infected, resorb, or collapse into the tracheal lumen. Bulky regional skin-muscle flaps may dehisce under tension or collapse into the tracheal lumen. Medial migration of the split ends of the anterior cartilaginous tracheal rings ensues with subsequent restenosis. Donor-site morbidity may compound these problems as well. During a 2.5-year period, we have performed laryngotracheoplasty on nine patients with 60% to 100% tracheal stenosis using titanium reconstruction plates. The split anterior tracheal wall is fixed by the plates in its expanded position. A neurovascularized strap-muscle flap is used to reconstruct the anterior tracheal wall. The flap becomes epithelialized with squamous epithelium within 3 weeks. Successful decannulation was possible in seven of the nine (78%) patients with no further respiratory problems. Of these, six required no further procedures. This technique offers a viable simple alternative to other methods of laryngotracheoplasty without the need for donor cartilage grafts or thick bulky skin-muscle flaps.