Local vascularized flaps for augmentation of reinke's space§

Authors

  • Seth H. Dailey MD,

    Corresponding author
    1. Department of Surgery/Division of Otolaryngology—Head and Neck Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
    • Department of Surgery/Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Ave. K4/720, Madison, WI 53792-7375
    Search for more papers by this author
  • McLean Gunderson DVM,

    1. Department of Surgery/Division of Otolaryngology—Head and Neck Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
    Search for more papers by this author
  • Roger Chan PhD,

    1. Department of Otolaryngology—Head and Neck Surgery, Southwestern Medical School University of Texas, Dallas, Texas, U.S.A.
    Search for more papers by this author
  • Jose Torrealba MD,

    1. Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
    Search for more papers by this author
  • Miwako Kimura MD, PhD,

    1. Department of Otolaryngology—Head and Neck Surgery, Southwestern Medical School University of Texas, Dallas, Texas, U.S.A.
    Search for more papers by this author
  • Nathan V. Welham PhD, CCC-SLP

    1. Department of Surgery/Division of Otolaryngology—Head and Neck Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
    Search for more papers by this author

  • The University of Texas is the institution where rheologic testing was performed and the resulting data analyzed. All other work was completed at the University of Wisconsin–Madison School of Medicine and Public Health.

  • All financial support was provided by the grants listed below. No other financial or material support occurred. Therefore, no financial disclosures are indicated.

  • §

    Title of Grant (1): Characterization and Treatment of the Scarred Vocal Fold; Source (1): NIH; Grant Number (1): 5R01DC004428; Title of Grant (2): High Resolution Ultrasound Imaging of Vocal Folds; Source (2): Internal Grant from Department of Surgery; UW Foundation. Title of Grant (3): Local Vascularized Flaps for Augmentation of Reinke's Space; Source (3): David Bradley Research Fund, Division of Otolaryngology—Head and Neck Surgery. Title of Grant (4): Biomechanical Characterization of Vocal Fold Tissues; Source (4): NIH; Grant number (4): 5R01DC006101-09.

  • The authors have no conflicts of interests to disclose.

Abstract

Objectives/Hypothesis:

The purpose of this study is to describe and test a novel surgical strategy for augmentation of Reinke's space using vascularized flaps: a thyroid ala perichondrium flap (TAP) and a composite thyroid ala perichondrium flap (CTAP) from the anterior larynx. We hypothesized that these specially designed vascularized flaps would remain viable once inset into the lamina propria, and that they would not disrupt rheologic, biomechanical, and histologic properties of the native vocal fold.

Study Design:

Experimental. In vivo canine model.

Methods:

The length and volume of test flaps harvested in six adult human cadaveric larynges were analyzed to determine suitability for use in augmentation in the lamina propria. Also, 12 beagles randomly underwent unilateral placement of either TAP or CTAP, which were designed in accordance with the human adult cadaveric experiments. Flap perfusion was measured before and after harvest with laser Doppler. After 1 month, the beagles were humanely sacrificed and their larynges subjected to aerodynamic and acoustic evaluation using an excised larynx apparatus. The vocal fold lamina propria of four larynges—two TAP and two CTAP—underwent rheologic evaluation using a simple-shear rheometer. The remaining eight larynges underwent quantitative histologic and immunohistochemical evaluation. The survival and complication (swallowing, airway, local wound) rates of all dogs were noted.

Results:

Initial studies with adult human cadaveric larynges established that TAP and CTAP possessed length and volume greater than native lamina propria. In the canine experiments, the perfusion change in the flaps was similar between flap groups. The damping ratio (ζ), dynamic viscosity (η′), elastic shear modulus (G′), and viscous shear modulus (G″) of treated and untreated native vocal folds were not statistically different. The glottic function measures of vocal efficiency, laryngeal resistance, jitter, shimmer, and harmonics-to-noise ratio (HNR) of treated and normal larynges were not statistically different. Similarly, the values for collagen, elastin, and glycosaminoglycans (GAGs) in treated and untreated vocal folds were not statistically different. Also, neither neochrondrogenesis nor neoosteogenesis was detected in any treated vocal fold. The values for vascular and cellular proliferation in treated and untreated vocal folds were not statistically different. All test dogs survived and had no complications related to swallowing, airway distress, or the local wound.

Conclusions:

The test flaps described and tested in this study appear to have conceptually attractive features for augmentation of Reinke's space. When placed in an in vivo setting TAP and CTAP did not reveal unfavorable vascular, rheologic, aerodynamic, acoustic, or histologic characteristics. There was no unanticipated morbidity or mortality to the test animals. Long-term viability of these flaps is unknown. TAP and CTAP may open novel pathways for correction of glottic defects and may offer crossover opportunities with tissue engineering techniques. Laryngoscope, 121:S37–S60, 2011

Ancillary