CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(01): 053-057
DOI: 10.1055/s-0040-1721522
Original Article

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction

Gautam Biswas
1  Department of Plastic and Reconstructive Surgery, TATA Medical Center, Kolkata, West Bengal, India
,
Karnav Bharat Panchal
1  Department of Plastic and Reconstructive Surgery, TATA Medical Center, Kolkata, West Bengal, India
,
Prateek V. Jain
2  Department of Head and Neck Surgery, TATA Medical Center, Kolkata, West Bengal, India
,
Kapila Manikantan
2  Department of Head and Neck Surgery, TATA Medical Center, Kolkata, West Bengal, India
,
Rajeev Sharan
2  Department of Head and Neck Surgery, TATA Medical Center, Kolkata, West Bengal, India
,
Pattatheyil Arun
2  Department of Head and Neck Surgery, TATA Medical Center, Kolkata, West Bengal, India
› Author Affiliations

Abstract

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.



Publication History

Publication Date:
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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