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

Abstract

Background. The demanding anatomic and mechanical requirements make the reconstruction of long tracheal defects challenging. Multiple attempts at replacing tracheal segments are described, including the use of autologous, allogeneic, and synthetic tissues. However, the multilayer structure of the trachea and its function as a conduit for air had generally resulted in the use of nonvascularized tissue and/or multistage procedures. Methods. The authors report on a 1-stage autologous reconstruction using local skin flaps for inner lining and a free medial femoral condyle corticoperiosteal-cutaneous (FCCPC) flap for the remaining layers. The skin island directly located over the FCCPC flap serves as an external coverage of the tracheal reconstruction.Results. Within the follow-up, the reconstructed trachea has retained its shape, diameter, and airway function. No notable stenosis or instability was observed. Conclusion. This concept combines ideal biological and mechanical tissue properties, offering the potential to meet the reconstructive requirements for extended tracheal defects.

Free posterior tibial artery perforator flap for 2‐stage tracheal reconstruction in patients after resection of well‐differentiated thyroid carcinoma invading the trachea

“…Therefore, appropriate reconstruction of the trachea following resection of malignancy is of great importance. Head and neck surgeons have used a wide variety of methods to reconstruct the trachea. However, each method has its own shortcomings.…”

“…However, tracheal reconstruction after tumor resection poses a great challenge for head and neck surgeons. A large number of approaches to tracheal reconstruction have been used, including tracheal end‐to‐end anastomosis, autologous rib cartilage graft, composite nasal septal graft, pedicled sternocleidomastoid clavicular periosteocutaneous flap, free radial forearm flap combined with biodegradative mesh suspension, free radial forearm flap combined with titanium mesh or rib cartilage, and other free skin grafts . With the development of microsurgical techniques, free skin grafts, such as radial free forearm and free thigh anterolateral flaps, have been widely applied for repairment and reconstruction after head and neck massive surgery.…”

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).…”