Plastic surgery of extensive defects of the anterior wall of the tracheaafter laryngo-tracheostomy
Abstract
<b>Introduction:</b> The problem of the closure of large laryngotracheal defects is relevant and continues to be the subject of research and discussions between otolaryngologists, thoracic and plastic surgeons. <b>Material and methods:</b> We examined 102 patients with defects of the anterior wall of the upper third of the trachea, subglottic larynx and soft tissue of the neck after laryngotracheostomy or tracheostomy. <b>Results and discussion:</b> 92 patients have anterior tracheal wall posttracheostomy defects and soft tissue defects with sizes from 1.0 sm to 2.0 sm wide and 2.0 sm to 4.0 sm in height when the defect depth of 8 mm, i.e. anterior-posterior size of the tracheal lumen and the lumen formed persistent airway narrowing in the plastic zone without a tread (T-shaped stent or tracheostomy cannula). These patients underwent the local three-layer or four-layer skin and muscle plastic operation of the defect. Six patients with extensive defects in the anterior-lateral walls of the trachea and the distal part of the larynx, underwent complex reconstructive surgery using microsurgical technics (fig. 1, 2). In 4 cases, the patients underwent plasty of defect by prefabricated autorib cartilage. <b>Conclusions:</b> With the size of the defect to 3-4.0 cm in length, sufficient depth of the lumen of the trachea the operation of choice is a skin-muscle plasty of a defect with the substitution of local tissues. Formation of rotational flaps, in particular autorib cartilage and delta-pectoral flap for reconstruction of extensive persistent tracheal defects and soft tissues of the neck is technically simple, framing the front wall without constriction and deformation lumen.