Laryngotracheal Reconstruction with a Prefabricated Flap

Abstract

Objective: Laryngotracheal stenosis can severely alter anatomy and leave patients with airway compromise. The majority of patients can be managed with conservative or open surgical procedures. Occasionally patients cannot be reconstructed with local tissues. We describe our experience with a prefabricated composite free flap to reconstruct patients with complicated laryngotracheal stenosis. Method: Case series of 2 patients with severe laryngotracheal stenosis treated with a prefabricated composite graft consisting of auricular cartilage and a radial forearm free flap. Both patients had compromised local tissue due to extensive neck surgery, previous radiation therapy, or chronic inflammation. Results: The prefabricated cartilage free flap allowed for a customized reconstruction. Prefabrication, implantation of the cartilage into the arm 6 weeks prior to flap harvest, maintained the integrity of the vascular cartilage graft. Furthermore, this reconstructive method provided satisfactory cosmetic and functional results. Both patients were decannulated. As the etiology, extent of the defect, and overall tissue quality of patients with laryngotracheal stenosis are variable, this composite flap may provide surgeons with additional means of laryngotracheal reconstruction in patients who have failed previous attempts or have compromised tissue biology. Conclusion: A prefabricated graft using auricular cartilage in a radial forearm free flap is a viable reconstructive option for laryngotracheal reconstruction in patients with large defects who are not candidates for conventional approaches.