Reconstruction of the cervical trachea using a prefabricated corticoperiosteal flap from the femur.
We treated a severe cervical fistula with a defect of tracheal cartilage using prefabrication of a corticoperiosteal flap combined with a cutaneous flap.The patient was a 16-year-old male with a cervical tracheal fistula that developed after a tracheostomy. Almost all the circumference of the trachea just below the cricoid cartilage up to the 4th tracheal cartilage had been lost.The reconstruction was performed in 2 series of operations as follows; repair of tracheal framework using a prefabricated corticoperiosteal flap, which was harvested from the femur and composed of a saphenous flap, and then complete closure using a local hinge flap and a free auricular cartilage graft. A free corticoperiosteal flap composed of a saphenous flap was transferred to the site just lateral to the defect. The corticoperiosteal flap, which has a flat shape, was bent in a reverse U-shaped semitubular fashion and the mucosal grafts were used to cover its inner surface. Two months later, the prefabricated corticoperiosteal flap and the saphenous flap were transposed leaving a part of the fistula as a tracheostoma. The remaining tracheostoma was closed secondarily. A satisfactory and stable result was obtained over an 8-year follow-up period.We believe that the procedure demonstrated here should be considered as a choice for the stable reconstruction of a cervical trachea.
Kashiwa
Katsuhiko
K
Departments of Plastic Surgery, Iwate Medical University, Morioka 020-8505, Japan.
Kobayashi
Seiichiro
S
Tono
Hisayuki
H
Nohara
Takaya
T
Honda
Takayuki
T
Sakurai
Shigeru
S
D000293:Adolescent; D005269:Femur / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D008297:Male; D009333:Neck; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D014132:Trachea / Q000601:surgery*; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects*; D014945:Wound Healing; D014947:Wounds and Injuries / Q000601:surgery