title: Vascularized composite autograft for adult laryngotracheal stenosis and reconstruction.
abstract: BACKGROUND
  Adult laryngotracheal reconstruction for airway stenosis and after oncologic ablation can be extremely challenging.
  
  
  METHODS
  Patients with the above conditions not amenable to or refractory to conventional treatments were offered specialized reconstruction by wrapping a contoured costal cartilage graft with a vascularized microvascular carrier. All constructs were lined with buccal mucosa grafts. Decannulation rates, quality of life questionnaires, and pulmonary function tests were performed and analyzed.
  
  
  RESULTS
  Eleven patients underwent this procedure, 6 for stenosis and 5 for laryngotracheal oncologic defects. Ten patients were successfully decannulated after the procedure (91%). Median time to decannulation was 4 months. At mean follow-up of 76 months, all evaluated patients had a serviceable voice, tolerated a normal diet, and had minimal subjective shortness of breath.
  
  
  CONCLUSIONS
  Vascularized composite autograft can be successfully used to treat severe subglottic stenosis or reconstruct large laryngotracheal defects not amenable to or refractory to conventional treatments.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network/Toronto General Hospital, University of Toronto, Ontario, Canada.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Rich
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network/Toronto General Hospital, University of Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network/Toronto General Hospital, University of Toronto, Ontario, Canada.
authors.forename: Stephan K
authors.initials: SK
authors.lastname: Haerle
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network/Toronto General Hospital, University of Toronto, Ontario, Canada.
authors.forename: Gian-Marco
authors.initials: GM
authors.lastname: Busato
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network/Toronto General Hospital, University of Toronto, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network/Toronto General Hospital, University of Toronto, Ontario, Canada.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts; D066186:Costal Cartilage / Q000098:blood supply / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007818:Laryngeal Diseases / Q000150:complications / Q000601:surgery; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D007830:Larynx / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery; D014132:Trachea / Q000293:injuries / Q000601:surgery*; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: chondrosarcoma; cricoid reconstruction; laryngotracheal reconstruction; laryngotracheal stenosis; subglottic stenosis; temporoparietal fascial flap; tracheal reconstruction; vascularized composite autograft (VCAG)