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J Reconstr Microsurg 2014; 30(03): 145-152
DOI: 10.1055/s-0033-1361928
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prefabrication and Prelamination Strategies for the Reconstruction of Complex Defects of Trachea and Larynx

J. J. Vranckx
1   Department of Plastic and Reconstructive Surgery, KU Leuven University Hospitals, Leuven, Belgium
,
M. Den Hondt
1   Department of Plastic and Reconstructive Surgery, KU Leuven University Hospitals, Leuven, Belgium
,
P. Delaere
2   Department of ENT, Head and Neck Oncology, KU Leuven University Hospitals, Leuven, Belgium
› Author Affiliations
Further Information

Publication History

23 September 2013

17 October 2013

Publication Date:
07 January 2014 (online)

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Abstract

Complex tracheal and laryngeal defects can be reconstructed using prelamination and prefabrication techniques. Three clinical situations are described in detail in the article. In short segment restenosis defects within scarred surroundings, we restore the fibrocartilaginous defect with a radial forearm fascia flap prelaminated with buccal mucosa or cartilage. This provides a newly vascularized inner lining to the tracheal defect and restores the tubular convexity. For long segment defects we need a technique that can withstand respiratory forces. We use a heterotopic prefabrication strategy to vascularize a tracheal allograft wrapped in forearm fascia. Chimerism is created by replacing donor respiratory epithelium with buccal mucosa of the recipient. After orthotopic transfer, this chimerism allows immunosuppression to be tapered and stopped when bronchoscopy shows mucosal integrity of the new trachea, since the recipient epithelium replaces the allogeneic inner tracheal lining by means of a chronic rejection process. A distinct situation occurs after resection of a unilateral larynx tumor, which usually results in a total laryngectomy with loss of both vocal cords, since reconstruction of the hemilarynx is considered too complex. First, we prefabricate a nearby four-ring autologous tracheal segment using radial forearm fascia. In a second stage, this orthotopically vascularized trachea restores the laryngeal structure with the aim to conserve one vocal cord and thus speech. Orthotopic and heterotopic prelamination and prefabrication strategies offer efficient and reproducible solutions for the restoration of challenging short and long segment tracheal defects, as well as unilateral laryngeal defects. The series in this review article are based on previous studies and case reports. The level of evidence is III—“Study of nonconsecutive patients, without a universally applied gold standard: case-control study”.

Keywords

prefabrication - prelamination - trachea reconstruction - larynx reconstruction - trachea transplantation
 

  • References

  • 1 Grillo HC. Tracheal replacement. Ann Thorac Surg 1990; 49 (6) 864-865
    CrossrefPubMedGoogle Scholar
  • 2 Delaere P, Vranckx J, Verleden G, De Leyn P, Van Raemdonck D ; Leuven Tracheal Transplant Group. Tracheal allotransplantation after withdrawal of immunosuppressive therapy. N Engl J Med 2010; 362 (2) 138-145
    CrossrefPubMedGoogle Scholar
  • 3 deLorimier AA, Harrison MR, Hardy K, Howell LJ, Adzick NS. Tracheobronchial obstructions in infants and children. Experience with 45 cases. Ann Surg 1990; 212 (3) 277-289
    CrossrefPubMedGoogle Scholar
  • 4 Wright CD, Grillo HC, Wain JC , et al. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg 2004; 128 (5) 731-739
    CrossrefPubMedGoogle Scholar
  • 5 Eliachar I, Roberts JK, Welker KB, Tucker HM. Advantages of the rotary door flap in laryngotracheal reconstruction: is skeletal support necessary?. Ann Otol Rhinol Laryngol 1989; 98 (1 Pt 1) 37-40
    PubMedGoogle Scholar
  • 6 Idriss FS, DeLeon SY, Ilbawi MN, Gerson CR, Tucker GF, Holinger L. Tracheoplasty with pericardial patch for extensive tracheal stenosis in infants and children. J Thorac Cardiovasc Surg 1984; 88 (4) 527-536
    PubMedGoogle Scholar
  • 7 Delaere P, Hierner R, Vranckx J, Hermans R. Tracheal stenosis treated with vascularized mucosa and short-term stenting. Laryngoscope 2005; 115 (6) 1132-1134
    CrossrefPubMedGoogle Scholar
  • 8 Delaere PR, Liu ZY, Hermans R, Sciot R, Feenstra L. Experimental tracheal allograft revascularization and transplantation. J Thorac Cardiovasc Surg 1995; 110 (3) 728-737
    CrossrefPubMedGoogle Scholar
  • 9 Ott LM, Weatherly RA, Detamore MS. Overview of tracheal tissue engineering: clinical need drives the laboratory approach. Ann Biomed Eng 2011; 39 (8) 2091-2113
    CrossrefPubMedGoogle Scholar
  • 10 Rose KG, Sesterhenn K, Wustrow F. Tracheal allotransplantation in man. Lancet 1979; 1 (8113) 433-434
    PubMedGoogle Scholar
  • 11 Vogel G. Trachea transplants test the limits. Science 2013; 340 (6130) 266-268
    CrossrefPubMedGoogle Scholar
  • 12 Yu P, Clayman GL, Walsh GL. Long-term outcomes of microsurgical reconstruction for large tracheal defects. Cancer 2011; 117 (4) 802-808
    CrossrefPubMedGoogle Scholar
  • 13 Pearson BW, Keith RL. Near-total laryngectomy. In: Johnson JT, Blitzer A, Ossoff RM, Thomas IR, , eds. American Academy of Otology-Head Neck Surgery. St Louis, United States: Mosby; 1990: 309-330
    Google Scholar
  • 14 Delaere P, Goeleven A, Poorten VV, Hermans R, Hierner R, Vranckx J. Organ preservation surgery for advanced unilateral glottic and subglottic cancer. Laryngoscope 2007; 117 (10) 1764-1769
    CrossrefPubMedGoogle Scholar
  • 15 Delaere PR, Vranckx JJ, Meulemans J , et al. Learning curve in tracheal allotransplantation. Am J Transplant 2012; 12 (9) 2538-2545
    CrossrefPubMedGoogle Scholar
  • 16 Delaere PR, Poorten VV, Goeleven A, Feron M, Hermans R. Tracheal autotransplantation: a reliable reconstructive technique for extended hemilaryngectomy defects. Laryngoscope 1998; 108 (6) 929-934
    CrossrefPubMedGoogle Scholar
  • 17 Delaere P, Goeleven A, Poorten VV, Hermans R, Hierner R, Vranckx J. Organ preservation surgery for advanced unilateral glottic and subglottic cancer. Laryngoscope 2007; 117 (10) 1764-1769
    CrossrefPubMedGoogle Scholar
  • 18 Delaere P, Vander Poorten V, Vranckx J, Hierner R. Laryngeal repair after resection of advanced cancer: an optimal reconstructive protocol. Eur Arch Otorhinolaryngol 2005; 262 (11) 910-916
    CrossrefPubMedGoogle Scholar
  • 19 Yao ST. Vascular implantation into skin flap: experimental study and clinical application: a preliminary report. Plast Reconstr Surg 1981; 68 (3) 404-410
    CrossrefPubMedGoogle Scholar
  • 20 Beck CS, Tichy VL. Production of collateral circulation to the heart: experimental study. Am Heart J 1935; 10 (Suppl. 07) 849-873
    CrossrefPubMedGoogle Scholar
  • 21 Pribaz JJ, Guo L. Flap prefabrication and prelamination in head and neck reconstruction. Semin Plast Surg 2003; 17 (9) 351-357
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Pribaz JJ, Fine NA. Prelamination: defining the prefabricated flap—a case report and review. Microsurgery 1994; 15 (9) 618-623
    CrossrefPubMedGoogle Scholar
  • 23 Guo L, Pribaz JJ. Clinical flap prefabrication. Plast Reconstr Surg 2009; 124 (6 Suppl): 340-348
    PubMedGoogle Scholar
  • 24 Klepetko W, Marta GM, Wisser W , et al. Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft. J Thorac Cardiovasc Surg 2004; 127 (3) 862-867
    CrossrefPubMedGoogle Scholar
  • 25 Mankin HJ, Buckwalter JA. Editorial: restoration of the osteoarthrotic joint. 1996; 78: 1-2
    PubMedGoogle Scholar
  • 26 Hendrickx B, Vranckx JJ, Luttun A. Cell-based vascularization strategies for skin tissue engineering. Tissue Eng Part B Rev 2011; 17 (1) 13-24
    CrossrefPubMedGoogle Scholar
  • 27 Vermeulen P, Dickens S, Degezelle K, Van den Berge S, Hendrickx B, Vranckx JJ. A plasma-based biomatrix mixed with endothelial progenitor cells and keratinocytes promotes matrix formation, angiogenesis, and reepithelialization in full-thickness wounds. Tissue Eng Part A 2009; 15 (7) 1533-1542
    CrossrefPubMedGoogle Scholar
  • 28 Zur KB, Urken ML. Vascularized hemitracheal autograft for laryngotracheal reconstruction: a new surgical technique based on the thyroid gland as a vascular carrier. Laryngoscope 2003; 113 (9) 1494-1498
    CrossrefPubMedGoogle Scholar