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Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction
Background The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer.
Method This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap.
Result At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.
30 November 2020 (online)
© 2020. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Walles T, Giere B, Hofmann M. et al. Experimental generation of a tissue-engineered functional and vascularized trachea. J Thorac Cardiovasc Surg 2004; 128 (06) 900-906
- 2 McCaffrey TV, Bergstralh EJ, Hay ID. Locally invasive papillary thyroid carcinoma: 1940-1990. Head Neck 1994; 16 (02) 165-172
- 3 Nishida T, Nakao K, Hamaji M. Differentiated thyroid carcinoma with airway invasion: indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Surg 1997; 114 (01) 84-92
- 4 Silberstein EB, Alavi A, Balon HR. et al. The SNMMI practice guideline for therapy of thyroid disease with 131I 3.0. J Nucl Med 2012; 53 (10) 1633-1651
- 5 Belsey R. Resection and reconstruction of the intrathoracic trachea. Br J Surg 1950; 38 (150) 200-205
- 6 Beldholm BR, Wilson MK, Gallagher RM, Caminer D, King MJ, Glanville A. Reconstruction of the trachea with a tubed radial forearm free flap. J Thorac Cardiovasc Surg 2003; 126 (02) 545-550
- 7 Maciejewski A, Szymczyk C, Półtorak S, Grajek M. Tracheal reconstruction with the use of radial forearm free flap combined with biodegradative mesh suspension. Ann Thorac Surg 2009; 87 (02) 608-610
- 8 Yu P, Clayman GL, Walsh GL. Human tracheal reconstruction with a composite radial forearm free flap and prosthesis. Ann Thorac Surg 2006; 81 (02) 714-716
- 9 Haykal S, Salna M, Waddell TK, Hofer SO. Advances in tracheal reconstruction. Plast Reconstr Surg Glob Open 2014; 2 (07) e178
- 10 Teng MS, Malkin BD, Urken ML. Prefabricated composite free flaps for tracheal reconstruction: a new technique. Ann Otol Rhinol Laryngol 2005; 114 (11) 822-826
- 11 Olias J, Millán G, da Costa D. Circumferential tracheal reconstruction for the functional treatment of airway compromise. Laryngoscope 2005; 115 (01) 159-161
- 12 Yu P, Clayman GL, Walsh GL. Long-term outcomes of microsurgical reconstruction for large tracheal defects. Cancer 2011; 117 (04) 802-808