Long-term outcomes of microsurgical reconstruction for large tracheal defects.
BACKGROUND
Reconstruction of large tracheal defects has been largely unsuccessful. The purpose of this study was to review the authors' experience with microsurgical reconstruction of these defects.


METHODS
Seven cases of microsurgical tracheal reconstruction were performed between May 2002 and April 2008. All but 1 patient had recurrent thyroid cancer; the other patient had primary adenocystic carcinoma of the trachea. The radial forearm free flap was used for lining in all cases. Rigid support was provided with a variety of prosthetic materials.


RESULTS
All defects involved the cervical trachea, with an average length of 5.8 cm ± 1.0 cm (range, 5 cm-7.5 cm). The width of defects ranged from half of the tracheal circumference to the entire circumference. Major complications included air leak in 4 patients, exposure and removal of prosthesis in 2 patients, and cardiopulmonary complications in 2 patients. One patient with postoperative retroperitoneal hematoma, abdominal compartment syndrome, and multiple organ failure died 2 months after surgery. Two patients died of other causes 1 year and 4 years, respectively, after surgery. The other 4 patients were alive and disease free, with follow-up ranging from 1 to 4.5 years. Four patients are asymptomatic, with normal speech and swallowing functions. Two patients remained tracheostomy dependent, but vocal ability was intact. All patients tolerated a regular diet.


CONCLUSIONS
Microsurgical reconstruction is a viable option in selected patients with large cervical tracheal defects that are beyond primary repair.
Yu
Peirong
P
Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. peirongyu@mdanderson.org
Clayman
Gary L
GL
Walsh
Garrett L
GL
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D014132:Trachea / Q000601:surgery; D014134:Tracheal Neoplasms / Q000601:surgery*; D014139:Tracheostomy; D016896:Treatment Outcome