Advantages of the rotary door flap in laryngotracheal reconstruction: is skeletal support necessary?

Most attempts at laryngeal reconstruction have sought to reestablish skeletal support. Bone and cartilage grafts have been used for this purpose, but they have often failed to maintain position in the larynx and/or trachea following reconstruction, and they tend to be reabsorbed. The rotary door flap can provide an undelayed, one-stage epithelial resurfacing of the larynx and trachea while simultaneously restoring luminal support without the need for transfer of cartilage or bone. Luminal support for the trachea is provided by the bulk, turgor, and anterior traction of the intact sternohyoid muscle, which serves as the carrier for the rotated skin island. During inspiration the intact muscle, whose points of attachment are anterior to the plane of the larynx and trachea, contracts and tends to open the airway to provide dynamic luminal support. The need for internal stenting is minimized. The technique is described and experience in 20 patients is presented.