title: Thyroid ala perichondrial flaps for subglottic reconstruction.
abstract: OBJECTIVE
  Techniques available for reconstruction of the cricotracheal region in adults are currently suboptimal. We sought to 1) understand the anatomic basis for the thyroid ala perichondrial flap, 2) describe the technique of harvesting and intraluminal placement, and 3) learn the limitations of defects for which it can be used.
  
  
  METHODS
  Cadaveric anatomical study.
  
  
  METHODS
  In fresh cadaveric specimens, the perichondrium of the outer layer of the thyroid cartilage was elevated by tracing the superior, medial, and lateral borders of each thyroid cartilage ala. The inferiorly based flap was then placed into the airway through the cricothyroid membrane. The extent of coverage was measured.
  
  
  RESULTS
  A total of 10 flaps were performed (6 male and 4 female). The average length of thyroid perichondrial flaps obtained was 1.67 cm. All flaps were able to completely cover the cricoid cartilage and extended to but did not cover the first tracheal ring. Once placed intraluminally, the flaps extended 2.4 cm below the vocal cords. Using both flaps enabled coverage of the entire anterior 180 degrees of the airway lumen in all specimens. There were no significant differences in male/female or right-sided/left-sided flaps.
  
  
  CONCLUSIONS
  The thyroid ala perichondrial flap is technically feasible and can provide coverage of anterior airway defects up to approximately 2.4 cm below the true vocal cords. This flap could enable transfer of vascularized tissue to aid in cricotracheal reconstruction.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati Ohio.
authors.forename: J Drew
authors.initials: JD
authors.lastname: Prosser
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Bush
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Postma
authors.forename: Paul M
authors.initials: PM
authors.lastname: Weinberger
mesh_terms: D000328:Adult; D002102:Cadaver; D003413:Cricoid Cartilage / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013957:Thyroid Cartilage / Q000601:surgery*; D014827:Vocal Cords / Q000033:anatomy & histology
keywords: Airway reconstruction; subglottic stenosis; thyroid perichondrial flap