Immediate tracheal reconstruction with forearm flap and bone graft

Kubo, Tateki; Kurita, Tomoyuki; Tashima, Hiroki; Suzuki, Motoyuki; Uemura, Hirokazu; Fujii, Takashi; Seike, Shien; Inohara, Hidenori; Hosokawa, Ko

doi:10.1002/micr.30365

Cited by 11 publications

(3 citation statements)

References 30 publications

(83 reference statements)

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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][14][15][16][17][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][20][21] and morbidity 20,[22][23][24] due to complications ( Table 2).…”

Section: Surgical Notessupporting

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: Surgical Notessupporting

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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“…In the literature, the myoperiosteal SCM flap, described by Friedman et al 39 and used for reconstruction of the trachea after WR, has been referred to as a soft tissue flap, muscle flap or a perichondrial flap 17,35,93,94,99,100 , which does not take into consideration the flap´s potential for calcification and the subsequent stability of the reconstructed trachea. This possible misinterpretation has often led to this technique being referred to in the same way as other reconstructive alternatives, although it has a different outcome on the patency of the airway and surgical morbidity and mortality.…”

Section: Thyroid Cancer Invading the Tracheamentioning

confidence: 99%

Anaplastic thyroid cancer and hyperfractionated accelerated radiotherapy (HART) with and without surgery

Jacobsen

Grøholt

Lorntzsen

et al. 2017

Eur Arch Otorhinolaryngol

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Anaplastic carcinoma of the thyroid gland (ATC) is one of the most aggressive cancers in humans. With insufficient treatment, the disease most often leads to death in suffocation. From 2002, our treatment strategy has been hyperfractionated accelerated radiotherapy (HART) with high doses (64 Gy) to the neck, followed by surgery 4-8 weeks later if feasible, with the aim to gain control in the neck. After a pathology review, 51 patients were diagnosed with ATC in the period 2002-2014 in the south-east of Norway. Thirty-one received HART, and we present a study of these patients, with death in suffocation as the primary endpoint and survival as the second. No patients treated with HART died in suffocation. Six had a tracheostomy during their course of disease, of whom four were dependent on a tracheal cannula when they died. The best median survival, 19 months, was obtained in the 13 patients where both radiotherapy and surgery were possible as primary treatments. Only surgery came out as a prognostic factor for survival in multivariate analysis. Patients surviving more than 2 years were characterised by having surgery with R0 resection and no or small residual foci of ATC in the specimens. Stage 4C patients survived 3 months only.

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“…We vertically inserted the rib cartilage into a pocket immediately below the dermis of the skin flap. Kubo reported the effectiveness of this procedure using a forearm flap ( 13 ). As an ALT flap is soft, it is easy to mould it to the irregularly shaped larynx and place trimmed cartilage grafts inside it.…”

Section: Discussionmentioning

confidence: 99%

Anaplastic thyroid cancer with long‑term survival with lenvatinib therapy and preservation of laryngeal function after one‑stage reconstruction: A case report

et al. 2021

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Laryngotracheal reconstruction is performed to treat locally advanced thyroid carcinoma invading the larynx and/or trachea. The reconstructive technique varies. The present report describes the case of a 71-year-old female patient who underwent surgery for thyroid carcinoma involving the larynx. Reconstructive surgical techniques were employed to maintain laryngeal structure and function. An anterolateral thigh flap with free rib cartilage grafts was used to compensate for laryngeal defects. Although a temporary tracheal stoma was constructed, it closed spontaneously after decannulation. Therefore, one-stage laryngeal reconstruction was accomplished. Post-operative histopathological examination revealed focal anaplastic changes in the lesion, which mainly consisted of papillary components. Post-operative positron emission tomography/computed tomography indicated early recurrence in the left side of the neck. Therefore, lenvatinib was started as adjuvant therapy. Complete response was observed with lenvatinib therapy. The patient was alive and had good laryngeal function 26 months after the operation. One-stage laryngeal reconstruction can reduce burden and improve quality of life in patients with thyroid carcinoma involving the larynx. Lenvatinib may be useful for treating early recurrence of anaplastic thyroid carcinoma after reconstructive surgery with a free flap.

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Immediate tracheal reconstruction with forearm flap and bone graft

Abstract: Creating a tracheostoma during the first operation prevents postoperative airway compromise. Our bone graft placement easily achieves tracheal rigidity. This procedure is simple and safe for tracheal window defect repair.

Cited by 11 publications

References 30 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

Anaplastic thyroid cancer and hyperfractionated accelerated radiotherapy (HART) with and without surgery

Anaplastic thyroid cancer with long‑term survival with lenvatinib therapy and preservation of laryngeal function after one‑stage reconstruction: A case report

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