The rotary door myocutaneous flap. A reliable technique for laryngotracheal reconstruction.

Abstract

We examined the possible uses of the "rotary door" sternohyoid myocutaneous flap (RDF) in laryngotracheal reconstruction. This well-vascularized myocutaneous flap, when rotated axially, can replace or widen the anterolateral walls of the airway. It provides a large epithelial surface, together with bulky structural support. The flap is readily available within the immediate surgical field and can replace large defects in the airway, from the level of the glottis to the cervical trachea. After extensive structural and soft-tissue loss of the larynx and trachea were produced to simulate commonly encountered traumatic and postsurgical stenotic conditions, the RDF was employed in 23 dogs in a single-stage laryngotracheal reconstruction. A stable, widely patent airway was achieved. The dogs were followed up for periods varying from three to six months. No complications or secondary stenoses were encountered. Photographic, radiologic, and endoscopic examinations demonstrated the viability and usefulness of this newly described flap. Long-term tracheostomy was used so that intraluminal stents and cannulas could be avoided. Histopathologic studies confirmed the integration of the RDF into the framework of the larynx and trachea. Application of this technique in cases of tumors, trauma, and stenosis of the airway is suggested.