Fabre Dominique, Fadel Elie, Mussot Sacha, Kolb Frederic, Leymarie Nicolas, Mercier Olaf, Le Chevalier Thierry, Dartevelle Philippe G
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Thoracic Oncology Institute, Paris Sud University, 133, Avenue de la résistance, 92350 Le Plessis Robinson, France.
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Thoracic Oncology Institute, Paris Sud University, Le Plessis Robinson, France.
Chin Clin Oncol. 2015 Dec;4(4):46. doi: 10.3978/j.issn.2304-3865.2015.12.07.
Surgical research has failed during fifty years to find an ideal substitute for the trachea after extended resection. All the prostheses could erode the adjacent structures or lead to infection or obstructive issues. Innovation in surgery development has been improved using novel techniques of plastic surgery. During the last ten years, we have developed a technique using free fasciocutaneous flaps. This allows us to construct tubes for tracheal replacement. The most accurate flap used for this technique is the forearm free flap (FFF). Reinforcement of the flap with autologous strips of cartilage harvested from the last ribs offers sufficient resistance to respiratory pressure. This technique is also completely autologous without any stent in the tracheal lumen. From 2004 to 2015 we have already reconstructed the trachea of 16 patients for 12 primary tracheal neoplasms [including 9 adenoid cystic carcinoma (ACC) and 3 squamous cell carcinoma (SCC)], 3 secondary tracheal Neoplasms and one for benign lesion. This article describes the indications, determination of resectability, patient selection, subheading for surgery, postoperative management and results of this technique.
五十年来，外科研究一直未能找到在广泛切除气管后理想的替代物。所有的假体都可能侵蚀邻近结构，或导致感染或阻塞问题。利用整形外科的新技术推动了外科手术的创新发展。在过去十年中，我们开发了一种使用游离筋膜皮瓣的技术。这使我们能够构建用于气管替代的管道。用于该技术的最精确皮瓣是前臂游离皮瓣（FFF）。用从最末肋骨获取的自体软骨条对皮瓣进行加固，可为呼吸压力提供足够的抵抗力。该技术也是完全自体的，气管腔内无需任何支架。从2004年到2015年，我们已经为12例原发性气管肿瘤[包括9例腺样囊性癌（ACC）和3例鳞状细胞癌（SCC）]、3例继发性气管肿瘤和1例良性病变重建了16例患者的气管。本文描述了该技术的适应证、可切除性的确定、患者选择、手术小标题、术后管理及结果。
