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Long-term outcomes of microsurgical reconstruction for large tracheal defects†
Article first published online: 24 SEP 2010
Copyright © 2010 American Cancer Society
Volume 117, Issue 4, pages 802–808, 15 February 2011
How to Cite
Yu, P., Clayman, G. L. and Walsh, G. L. (2011), Long-term outcomes of microsurgical reconstruction for large tracheal defects. Cancer, 117: 802–808. doi: 10.1002/cncr.25492
This study was presented in part at the 84th Annual Meeting of the American Association of Plastic Surgeons; May 8-11, 2005; Scottsdale, Arizona.
- Issue published online: 3 FEB 2011
- Article first published online: 24 SEP 2010
- Manuscript Accepted: 28 APR 2010
- Manuscript Revised: 13 APR 2010
- Manuscript Received: 21 JAN 2010
- tracheal reconstruction;
- radial forearm flap;
- tracheal tumor;
- thyroid cancer;
- tracheal stent;
- air leak
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.
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.
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.
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.