Laryngotracheal reconstruction using prefabricated and preconditioned composite radial forearm free flaps. A report of two cases.
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.
Schipper
Jörg
J
Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University, Killianstrasse 5, 79106 Freiburg, Germany. joerg.schipper@med.uni-duesseldorf.de
Ridder
Gerd Jürgen
GJ
Maier
Wolfgang
W
Teszler
Christian Barna
CB
Horch
Raymund E
RE
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