Long-term outcomes of microsurgical reconstruction for large tracheal defects

Authors

  • Peirong Yu MD, MS,

    Corresponding author
    1. Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Plastic Surgery, Unit 443, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
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    • Fax: (713) 794-5492

  • Gary L. Clayman DMD, MD,

    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Garrett L. Walsh MD

    1. Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • This study was presented in part at the 84th Annual Meeting of the American Association of Plastic Surgeons; May 8-11, 2005; Scottsdale, Arizona.

Abstract

BACKGROUND:

Reconstruction of large tracheal defects has been largely unsuccessful. The purpose of this study was to review the authors' experience with microsurgical reconstruction of these defects.

METHODS:

Seven cases of microsurgical tracheal reconstruction were performed between May 2002 and April 2008. All but 1 patient had recurrent thyroid cancer; the other patient had primary adenocystic carcinoma of the trachea. The radial forearm free flap was used for lining in all cases. Rigid support was provided with a variety of prosthetic materials.

RESULTS:

All defects involved the cervical trachea, with an average length of 5.8 cm ± 1.0 cm (range, 5 cm-7.5 cm). The width of defects ranged from half of the tracheal circumference to the entire circumference. Major complications included air leak in 4 patients, exposure and removal of prosthesis in 2 patients, and cardiopulmonary complications in 2 patients. One patient with postoperative retroperitoneal hematoma, abdominal compartment syndrome, and multiple organ failure died 2 months after surgery. Two patients died of other causes 1 year and 4 years, respectively, after surgery. The other 4 patients were alive and disease free, with follow-up ranging from 1 to 4.5 years. Four patients are asymptomatic, with normal speech and swallowing functions. Two patients remained tracheostomy dependent, but vocal ability was intact. All patients tolerated a regular diet.

CONCLUSIONS:

Microsurgical reconstruction is a viable option in selected patients with large cervical tracheal defects that are beyond primary repair. Cancer 2011. © 2010 American Cancer Society.

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