title: Laryngotracheal reconstruction using prefabricated and preconditioned composite radial forearm free flaps. A report of two cases.
abstract: OBJECTIVE
  Total or subtotal laryngectomy performed as surgical treatment of locally advanced laryngeal tumors requires a permanent laryngostomy or tracheostomy, and are both associated with severe and lifelong disability. The hitherto published reconstructive methods for the rehabilitation of patients after subtotal anterior laryngotracheal resection of extended laryngotracheal malignancies have not been thoroughly convincing.
  
  
  METHODS
  We present a successful method of extended laryngotracheal reconstruction that combines modern surgical and biomedical techniques.
  
  
  RESULTS
  A stable three-dimensional anterior neolarynx was prefabricated, including the use of vacuum-assisted prelamination and preconditioning of a composite radial forearm free flap, which was then transferred to the neck and vascularized by microvascular anastomosis to the cervical vessels. This reconstructive procedure permitted the restoration of a stable laryngotracheal conduit in two cases, with the subsequent successful closure of the tracheo-laryngostomy.
  
  
  CONCLUSIONS
  In the reported cases the pre- or post-operative irradiation did not compromise the success of reconstruction. Not only did our technique facilitate the rehabilitation of patients suffering from drawbacks of the laryngo-tracheofissure, but it also assisted in avoiding total laryngectomy in cases of advanced anterior laryngeal cancer by extending the indications for subtotal anterior laryngeal resections followed by reconstructive surgery.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University, Killianstrasse 5, 79106 Freiburg, Germany. joerg.schipper@med.uni-duesseldorf.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Schipper
authors.forename: Gerd Jürgen
authors.initials: GJ
authors.lastname: Ridder
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Christian Barna
authors.initials: CB
authors.lastname: Teszler
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
mesh_terms: D002356:Cartilage / Q000637:transplantation; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D014134:Tracheal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D014139:Tracheostomy