Use of a Scapular Free Flap for Reconstruction of the Cricoid Cartilage in Pharyngolaryngeal Oncology

Microvascular cricoid cartilage reconstruction with the thoracodorsal artery scapular tip autogenous transplant

“…Our patient reported excellent postoperative speech and swallowing function. Her results compare favorably with those previously reported,2, 3, 5, 6 and her ability to return to a profession in which she regularly uses her voice reflects her confidence in her ability to communicate and be understood.…”

“…Gilbert and Neligan have shown excellent results with the use of the temporoparietal free flap as a vascular carrier for a cartilage graft for patients undergoing hemilaryngectomy with preservation of the cricoid after radiation failure 2. Mayot et al reported the results of three innovative cases, in which the cricoid cartilage was reconstructed after vertical or anterior hemilaryngectomy using free vascularized bone from the lateral border of the scapula based on the circumflex scapular artery 3. Radiation therapy had no adverse effects on the vascularized bone at follow‐up intervals of 10 to 18 months, but the bone could not be contoured into a partial circle.…”

“…In addition to restoring the cartilaginous framework of the larynx, promotion of primary healing and prevention of granulation and subsequent stenosis are important goals of reconstruction. To accomplish these goals, numerous options have been suggested that include temporoparietal flaps, free cartilage grafts, radial forearm free tissue transfers, and tracheal autotransplantation with vascular carriers 1–6. Delaere et al have pioneered the reconstruction of the cricoid with a rigorous scientific methodology that has transformed the approach to cricoid resection and reconstruction.…”

Tracheal Autotransplantation: A Reliable Reconstructive Technique for Extended Hemilaryngectomy Defects

“…Tissues with all the desired requirements for optimal repair of extended hemilaryngectomy defects are not readily available. Attempts to reconstruct hemicricolaryngectomy defects have used regional cartilage strips 3,4 and scapular bone 5 . Although sporadic successes may have been reported, cartilage or bone are both unreliable because they do not respond to the tissue requirements for extended hemilaryngectomy repair.…”

Rekonstruktion nach ausgedehnten Larynx- und Hypopharynxteilresektionen Eine neue Methode mit Rippenknorpel, Chondrosynthese und freien Radialistransplantaten

“…Die funktionellen Ergebnisse sind neben verschiedenen individuellen Faktoren sowohl von dem Defekt als auch von dessen Rekonstruktion abhängig. Zur Verbesserung der funktionellen Ergebnisse nach ausgedehnten Teilresektionen sind Defektrekonstruktionen mit gestielten Haut- [7] und Myokutanlappen [25,29] sowie mit freien "composite grafts" aus der Nasenscheidewand [26] und mikrovaskulär reanastomosierten Skapula- [15] und Radialistransplantaten [4, 5, 28] angegeben worden. Übereinstimmend berichten aber viele Autoren über z. T. schwere Aspirationsprobleme [10,12,14,25], die in bestimmten Fällen entweder eine "prophylaktische" [25] oder eine sekundäre [2], ausschließlich funktionell -nicht onkochirurgisch -indizierte totale Laryngektomie erfordern.…”