title: [Successful treatment of subglottic tracheal stenosis with a mucosa-lined radial forearm fascia flap].
abstract: Short-segment tracheal stenosis is often treated by segmental resection and end-to-end anastomosis. Longer-segment stenosis can sometimes be treated using dilation, laser therapy, bronchoscopic stent insertion and segmental resection and reconstruction. Long-segment restenosis with a buildup of scar tissue due to successful resection surgery in the past represents a particular therapeutic challenge and a sufficiently vascularized transplant may be the only option. We describe the case of a 37-year-old patient who underwent a tracheal reconstruction using a mucosa-lined radial forearm flap. Subsequent to a traumatic laryngotracheal fracture, long-term ventilation and multiple surgical interventions, the patient had developed a functionally relevant subglottic stenosis (5.5 cm). Following longitudinal anterior resection of the trachea 1 cm above and below the stenosis, a Dumon® stent was inserted. Simultaneously, a radial forearm fascia flap was harvested, as were two full-thickness buccal mucosa grafts, which were sutured onto the subcutaneous tissue and fascia of the forearm flap. Beginning caudally, the mucosa-lined flap was then sutured, air-tight, into the anterior tracheal defect with the mucosa facing the lumen. Finally, end-to-end anastomosis connected the blood vessels of the radial forearm flap to the recipient blood vessels in the neck. The patient was successfully extubated after 24 h and discharged after 5 days. A postoperative CT scan revealed optimal placement of the stent and the patient's speech and breathing were sufficiently re-established. The stent was removed bronchoscopically 6 weeks after surgery. Examinations during the 6-month follow-up period showed that the diameter of the reconstructed airway was retained and the patient remained symptom-free.
authors.affiliation: Klinik für Hals-Nasen-Ohren-Heilkunde, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland. magis.mandapathil@uk-essen.de
authors.forename: M
authors.initials: M
authors.lastname: Mandapathil
authors.forename: T K
authors.initials: TK
authors.lastname: Hoffmann
authors.forename: L
authors.initials: L
authors.lastname: Freitag
authors.forename: N
authors.initials: N
authors.lastname: Reddy
authors.forename: S
authors.initials: S
authors.lastname: Lang
authors.forename: P
authors.initials: P
authors.lastname: Delaere
mesh_terms: D000328:Adult; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005542:Forearm / Q000601:surgery*; D006801:Humans; D009092:Mucous Membrane / Q000637:transplantation*; D013524:Surgical Flaps; D014135:Tracheal Stenosis / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome