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

Liu, Jun; Lü, Dan; Deng, Di; Ji, Wang; Gan, Weigang; Zou, Jian; Chen, Fei; Yang, Hui

doi:10.1002/hed.25675

Cited by 15 publications

(16 citation statements)

References 17 publications

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“…In our study, postoperative stenosis was not observed clinically or on tracheoscopy at follow‐up. Comparing the findings of our study with those of other series on patients with TC using different techniques, the SCM periosteal flap seemed superior to free flaps and secondary closure in terms of achieving a stable airway 13‐18 with a low percentage of permanent tracheostomies. Series of ETE anastomoses or sleeve resections showed good results in terms of establishing a stable airway; however, many of the results demonstrated non‐negligible mortality 19‐21 and morbidity 20,22‐24 due to complications (Table 2).…”

Section: Discussionsupporting

confidence: 65%

From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer

Lorntzsen

Brøndbo

Osnes

2020

Laryngoscope Investig Oto

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Objectives: We aimed to evaluate the outcomes of tracheal window resection and reconstruction using a vascularized periosteal flap (intended for calcification) harvested from the medial clavicle. This is one of several surgical techniques for tracheal resection and reconstruction used for patients with thyroid carcinoma invading the trachea. Importantly, in partial tracheal resection postoperative dynamic airway collapse must be prevented. Reconstruction of the tracheal defect with a vascularized periosteal flap is one method of achieving a stable airway. Methods: Twelve patients with locally advanced thyroid carcinoma who underwent tracheal resection and reconstruction at Oslo University Hospital from 2004 to 2017 were studied retrospectively. The primary outcome was a stable airway not requiring airway stenting. The secondary outcomes were the time to decannulation, morbidity, and survival. Results: Eleven of 12 patients did not require airway stenting postoperatively after a median of 111 days. Seven patients developed postoperative complications. The median observation time was 74.8 months (range 10.5-153.5) for all patients. The median disease-free survival was 40 months (range 0-147). By February 1, 2020, seven patients were alive, of whom five showed no evidence of disease. Conclusions: Tracheal reconstruction with a vascularized periosteal flap yielded good results in terms of establishing a stable airway. This procedure is a viable reconstructive option that allows for decannulation by preventing airway collapse, thereby potentially mitigating the need for end-to-end (ETE) anastomosis or sleeve resections. For selected patients, this procedure may prevent local fatal complications from thyroid cancer invading the trachea.

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Section: Discussionsupporting

confidence: 65%

From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer

Lorntzsen

Brøndbo

Osnes

2020

Laryngoscope Investig Oto

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“…Compared with that of parotid, temporal, and hypopharynx defects, the reconstruction of tracheal defects is usually completed in a narrow space, so there are higher requirements for the freedom of tissue placement. Therefore, when there are blood vessels in the recipient area, free flaps may be suitable for tracheal reconstruction, which is also related to the length [12,14,15], but they also have some disadvantages. ALT flaps are also ideal for head and neck reconstruction, as they are easy to harvest and provide rich tissue volumes and types.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

Deng

Liu

et al. 2020

BMC Surg

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Background Large or complex trachea defects often require some tissue to reconstruct, various flaps have been reported for reconstructing this defect. However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction. Therefore, this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction. Methods Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed. Results All of the pedicled TAAP flaps in our study survived. The flap size ranged from 2 cm × 5 cm to 4 cm × 10 cm, and the size of each island of one double-island flap was 2 cm × 2.5 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities, such as diabetes, hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis. Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment. Conclusion Pedicled TAAP flaps provide a short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

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“…Therefore, when there are blood vessels in the recipient area, free aps may be suitable for tracheal reconstruction, which is also related to the length of the pedicle. Free radial forearm aps, anterolateral thigh (ALT) aps and posterior tibial artery perforator aps have been successfully used for the reconstruction of tracheal defects [12,14,15] , but they also have some disadvantages. ALT aps are also ideal for head and neck reconstruction, as they are easy to harvest and provide rich tissue volumes and types.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

Deng

Liu

et al. 2020

Preprint

Self Cite

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Background Large or complex trachea defects often require some tissue to reconstruct,various flaps have been reported for reconstructing this defect.However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction.Therefore,this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction. Methods Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed. Results All of the pedicled TAAP flaps in our study survived. The flap size ranged from 5 cm by 2 cm to 4 cm by 10 cm, and the size of each island of one double-island flap was 2.5 cm by 2 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 cm and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities,such as diabetes,hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis.Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment. Conclusion Pedicled TAAP flaps provide a hairless inner lining, short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects,especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

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

Cited by 15 publications

References 17 publications

From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer

From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer

Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

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