Complex adult laryngotracheal reconstruction with a prefabricated flap: A case series

Detwiller, Kara Y.; Schindler, Joshua S.; Schneider, Daniel; Lindau, Robert; Wax, Mark K.

doi:10.1002/hed.23335

Cited by 14 publications

(30 citation statements)

References 14 publications

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“…Urken et al reported one of the first descriptions of reconstructing a hemicricoid and hemilaryngeal defect, with a sensate radial forearm free flap using costal cartilage in patients with partial laryngopharyngectomies . Prefabricated radial forearm free flaps using auricular cartilage has also been described in both the adult and pediatric populations for laryngotracheal stenosis . These cases demonstrate the utility in composite free flaps in airway reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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Prefabricated auricular cartilage radial forearm free flap reconstruction for cricoid chondrosarcoma

2015

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This case describes a subtotal cricoid cartilage defect reconstructed with a prefabricated composite free flap. A 61-year-old man with a chondrosarcoma of the cricoid cartilage required a subtotal cricoidectomy. The resulting defect was successfully reconstructed with a two-stage prefabricated radial forearm free flap utilizing auricular cartilage. Our case further adds to the evidence that prefabricated flaps are reliable in airway reconstruction. Additionally, this provides another option for laryngeal preservation in patients with laryngeal chondrosarcoma.

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Section: Discussionmentioning

confidence: 99%

“…Restoring the integrity of the complete ring of the cricoid cartilage and mucosa can ameliorate some of these issues by recreating structural stability and internal lining, but this remains challenging . Recently, vascularized carriers have been implemented for transplanting cartilage and bone to reconstruct cricoid defects …”

Section: Introductionmentioning

confidence: 99%

Prefabricated auricular cartilage radial forearm free flap reconstruction for cricoid chondrosarcoma

2015

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“…The cartilage graft is then placed with its convex aspect against the subcutaneous fat within the suprafascial plane of the SCAIF and tacked in place with absorbable monofilament suture. The elevated portions of the SCAIF are then replaced, and the incision is closed in standard fashion.…”

Section: Methodsmentioning

confidence: 99%

“…In 2013, Detwiller and colleagues described a technique to repair complicated TS utilizing auricular cartilage graft prefabricated within the radial forearm free flap (pRFFF) in patients deemed unsuitable for primary tracheal resection . Although pRFFF reconstruction has been successful in these high‐risk patients, the procedure adds increased operative time, requires microvascular surgery experience and training, and presents a risk of donor site complications such as tendon exposure especially among diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

The prefabricated supraclavicular artery flap in high‐risk tracheal stenosis patients

et al. 2019

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Objectives/Hypothesis Primary tracheal resection in appropriately selected patients with tracheal stenosis achieves >90% success rate. Risk factors for complications have been identified, making some patients high risk for this procedure. Herein is a review and discussion of a novel treatment method for tracheal stenosis utilizing a prefabricated composite auricular cartilage graft embedded in a supraclavicular artery island flap (pSCAIF) for tracheal reconstruction in high‐risk patients. Study Design Retrospective case series. Methods After institutional review board approval, cases were analyzed after data collection. Between 2014 and 2016, eight patients underwent airway reconstruction using an auricular cartilage graft prefabricated within a supraclavicular artery island flap reconstruction; all of these were included in the study. Each case was reviewed, and relevant details of patient and disease characteristics, operative course, postoperative course, decannulation, and status at last follow‐up were isolated and reported. Results Seven of eight patients were female. The most common cause of stenosis was iatrogenically induced multilevel stenosis (7/8 patients). All patients had undergone prior airway procedures, were high risk based on comorbid conditions, and underwent grafting and reconstruction with a composite supraclavicular island flap. All patients continue to follow up in a multidisciplinary clinic, and at last follow‐up, eight of eight patients were successfully decannulated. Conclusions The pSCAIF is a novel method for tracheal reconstruction. The analysis of the prefabricated locoregional approach cohort supports its utility for tracheal reconstruction in patients with complicated multilevel stenosis and adverse comorbidities and characteristics. Level of Evidence 4 Laryngoscope, 130:641–648, 2020

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“…Airway reconstruction with microvascular free flaps using both autologous and prosthetic composite grafts has been previously described in the adult population. Detwiller et al demonstrated that a delayed prefabricated graft using auricular cartilage and a radial forearm free flap was a viable reconstructive option in an adult series with complex laryngotracheal stenosis. This method allowed for transfer of a vascularized cartilage graft in patients who had unsuccessful previous airway reconstructions.…”

Section: Introductionmentioning

confidence: 99%

Pediatric airway reconstruction with a prefabricated auricular cartilage and radial forearm free flap

et al. 2015

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Prefabricated composite free flaps for complex airway reconstruction have been described for an adult series at our institution. We extended this approach to a pediatric patient with lifelong subglottic stenosis who had failed previous open airway reconstructions. A staged procedure was utilized in which a composite graft was created using conchal cartilages and a radial forearm free flap. This reconstruction improved the patency of her airway and decreased her dependency on intermittent airway dilations. Airway reconstruction with prefabricated conchal cartilage composite free flaps may be used as a salvage procedure for complex pediatric airway reconstruction when other methods have failed.

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Complex adult laryngotracheal reconstruction with a prefabricated flap: A case series

Abstract: A delayed prefabricated graft using auricular cartilage in a radial forearm free flap is a viable surgical intervention in patients with complex adult LTS who are not candidates for conventional approaches.

Cited by 14 publications

References 14 publications

Prefabricated auricular cartilage radial forearm free flap reconstruction for cricoid chondrosarcoma

Prefabricated auricular cartilage radial forearm free flap reconstruction for cricoid chondrosarcoma

The prefabricated supraclavicular artery flap in high‐risk tracheal stenosis patients

Pediatric airway reconstruction with a prefabricated auricular cartilage and radial forearm free flap

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