Reconstruction of the Trachea With Pedicle Skin Flap

Abstract

After the removal of the trachea with malignant struma, the new trachea was created with a pedicle skin flap of the neck based on the clavicular portion. The skin incision was made lateral downward from the left upper end of the curved horizontal incision for the strumectomy in such a way as the breadth of the skin flap corresponds with the length of the circumference of the trachea, and the skin was peeled off under the platysma.In the first case which the membraneous portion of the trachea was preserved, the median margin of the skin-flap was sutured to the membraneous portion. Then, the skinflap was rotated and its upper margin was sutured to the lower end of the larynx and its lateral margin to the membraneous portion of the trachea on the opposite side. This new trachea covered with a skin on the anterior neck.In the second case which the trachea was entirely removed, the lower portion of the median margin of the skinflap was first sutured to the posterior part of the end of the trachea. After that, its median and lateral margins were sutured together and the tube was created so as to face the skin inward. The upper end of this tube was connected to the lower end of the larynx.A small opening remained on the lower end of the new trachea, because the bilateral recurrent laryngeal nerve paralysis existed in both cases. This tracheostoma may be secondarily closed after the dyspnea is controled.