Abstract
Objectives: To demonstrate the impact of modern prelamination and preconditioning techniques for manufacturing a stable flap for laryngotracheal reconstruction after subtotal laryngectomy.
Methods: In 2 patients who had undergone subtotal laryngectomy with partial resection of the upper trachea and postoperative irradiation for extended laryngeal cancer, we formed a bilaterally epithelisized forearm flap under application of vacuum-assisted prelamination technique. Stabilization of the flap was achieved by insertion of rib cartilage during the preconditioning period. In a second surgical session, the flap was transferred to the throat and vascularized by microvascular anastomosis to cervical vessels.
Results: In both patients, surgery was successful and resulted in closure of the tracheostoma, and in speech and swallowing rehabilitation. The neolarynx remained stable during the follow-up period of 12 months.
Conclusion: Subtotal laryngectomy requiring a permanent laryngostoma or tracheostoma is associated with severe impairment of the patient and lifelong reduction of his quality of life. Reconstructive methods after subtotal anterior laryngotracheal resection published so far have not really been convincing. We present a successful method, combining the modern surgical and biomedical techniques of prelamination and preconditioning for extended laryngotracheal reconstruction, resulting in the restoration of a stable neolarynx and upper trachea. Our report indicates that previous or subsequent irradiation is no contraindication to this reconstruction procedure.
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