A Full-Thickness Chondrocutaneous Flap from the Auricular Concha for Repair of Tracheal Defects

Abstract

A free full-thickness chondrocutaneous flap from the auricular concha for the repair of large tracheal defects was transferred successfully. The flap is based on the superficial temporal vessels (reversed flow) and the posterior auricular vessels. The advantages of this flap for the repair of tracheal defects are (1) its dissection is easy, (2) thin components of the flap provide a wide postoperative airway, (3) the structure of the reconstructed trachea is made firm by the conchal cartilage with vascularization, (4) the highly vascularized cartilage results in less resorption than a free cartilage graft, (5) the donor site can be repaired easily and is concealed by the remnant auricle, and (6) a long arterial pedicle (reversed flow) can be obtained. The disadvantages are (1) there may be temporary postoperative congestion of the flap, (2) postoperative narrowing of the auriculocephalic sulcus may occur, and (3) a short venous pedicle often requires a vein graft.

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).…”

Reconstruction of an Inner Layer Defect of the Upper Eyelid With Avulsion of the Superior Levator Palpebrae Muscle and Orbital Fat

“…8,9 However, this flap was difficult to use in our patient because of its uncertain vascularity and relatively short pedicle. Because the supraorbital vessels and the angular vessels were injured and there was no reliable recipient vessel for anastomoses around the eyelid, a long pedicle and thin dermis were essential for the flap.…”