Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, NSW, Australia.
J Plast Reconstr Aesthet Surg. 2012 Dec;65(12):1645-53. doi: 10.1016/j.bjps.2012.07.008. Epub 2012 Aug 22.
Reconstruction of the trachea following resection for malignancy is challenging. We present our experience over a 5-year period, and a reconstruction algorithm with particular emphasis on minimising complications associated with radiotherapy.
A maximum of six tracheal rings can be resected and anastomosed primarily with acceptable tension. A more conservative approach is required in an irradiated trachea. For a limited defect localised anteriorly or laterally, a tracheal flap can be fashioned. As for more eccentric defects, an option is to convert the defect into an asymmetrical segmental defect, and to primarily anastomose the trachea with rotation of the distal stump. Our workhorse loco-regional flaps for patch reconstruction or suture line reinforcement include the sternocleidomastoid, internal mammary artery perforator and pectoralis major myocutaneous flaps. For extensive defects, a radial forearm free flap (RFFF) with rib cartilage struts for rigidity provides a good solution.
Fifteen patients (M:F = 4:11, median age 69 years) were identified. Six cases were locally aggressive papillary thyroid cancer. Mean follow-up was 17 months. Five and two patients had had radiotherapy prior to and following tracheal resection, respectively. Nine patients were extubated at the end of surgery, two were successfully decannulated from their T tube subsequently, and one from his tracheostomy. The two surgical complications included a partial RFFF dehiscence causing minor air leak, and major haemorrhage that warranted urgent operation and pectoralis major flap reconstruction.
Reconstruction of the trachea requires individualised techniques suited to the patient's body habitus, co-morbidity, previous treatment and the configuration of the defect.
恶性肿瘤切除后重建气管具有挑战性。我们展示了我们在 5 年期间的经验，以及一种重建算法，特别强调减少与放疗相关的并发症。
最多可以切除和吻合 6 个气管环，且在可接受的张力下吻合。在接受放疗的气管中，需要采用更保守的方法。对于局限性的前部或侧部较小的缺损，可以形成气管皮瓣。对于更偏心的缺损，一种选择是将缺损转换为非对称节段性缺损，并通过旋转远端残端来直接吻合气管。我们用于补丁重建或缝线加固的局部区域性皮瓣包括胸锁乳突肌、内乳动脉穿支和胸大肌肌皮瓣。对于广泛的缺损，带有肋软骨支柱的游离桡动脉前臂皮瓣（RFFF）提供了良好的解决方案。
确定了 15 名患者（男：女=4：11，中位年龄 69 岁）。6 例为局部侵袭性甲状腺乳头状癌。平均随访时间为 17 个月。5 例和 2 例患者分别在气管切除术前和术后接受过放疗。9 例患者在手术结束时拔管，2 例随后成功从 T 型管拔管，1 例从气管造口拔管。2 例手术并发症包括部分 RFFF 裂开导致轻微漏气，以及需要紧急手术和胸大肌皮瓣重建的大出血。
气管重建需要个体化的技术，适合患者的身体形态、合并症、先前的治疗和缺损的形态。
