Objective： To study the possibility of using portions of deepithelialized myocutaneous flaps to the reconstruction of thoracic tracheal defects after resection of a large tumor. Methods： From June 2007 to June 2012,...Objective： To study the possibility of using portions of deepithelialized myocutaneous flaps to the reconstruction of thoracic tracheal defects after resection of a large tumor. Methods： From June 2007 to June 2012, five cases of defects of the thoracic trachea were reconstructed by applying portions of deepithelialized myocutaneous flaps. The patients were 27-61 years old with 4 male cases and 1 female. The cervical trachea ranged in diameter from 4-8.5 cm with circumferences of approximately 1/3-2/5 of the bronchial circumference. Results： M1 five patients with thoracic tracheal defects after resection of a large tumor were cured of portions of deepithelialized myocutaneous flaps, with no tracheal stricture remaining and vomica successfully eliminated. During the first 1 to 3 months after the operation, bronchoscopy showed that the tracheal lumens were smooth, and the visible skin of the musculocutaneous flaps became gray and exhibited a small amount of white discharge. Conclusions： Despite this being a small series and short follow-up, this thoracic tracheal reconstruction with portions of deepithelialized myocutaneous flaps shows encouraging preliminary results and could be an alternative to other methods for the treatment of carefully selected patients with thoracic tracheal defects.展开更多
To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the s...To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum was used to reconstruct the tracheal defect when the blood supply to the ipsilateral sternocleidomastoideus was destroyed because of lymphonode clearing or radiotherapy.The pedicle of the musculo-periosteum flap was dissected adequately and the blood supply was protected carefully.Results All flaps survived with epithelization and osteogenesis.The endotracheal tubes were pulled out safely without trachea stenosis in all the patients.Conclusion The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum could reconstruct the tracheal defect when the ipsilateral blood supply was damaged.This method extends the application of the musculo-periosteum flap.3 refs,4 figs.展开更多
Objective:The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies.Methods:The retrospective study was designed to analyze patients with diagnosed primary or...Objective:The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies.Methods:The retrospective study was designed to analyze patients with diagnosed primary or secondary tracheal tumors from 1991 to 2020.Surgical techniques,complications and prognosis were reviewed.Airway status and patient outcomes were the principal follow-up measures.Tracheal defects were classified into two plane sizes(vertical(V)and horizontal(H)planes).Vertical defects were further categorized into three groups based on their tracheal ring numbers(V 1,≤5 rings;V 2,6-10 rings;and V 3,>10 rings).Tracheal defects with horizontal plane size H 1 and H 2 represent defects less and more than one-half the circumference of trachea.Thus,suitable reconstruction strategies were planned primarily based on"V"and"H"classifications.The reconstruction strategies performed were sleeve resection followed by an end-to-end anastomosis,window resection with sternocleidomastoid myoperiosteal flap reconstruction,defects conversion with rotation anastomosis,and modified tracheostomy with secondary flap reconstruction.Results:A total of 106 patients diagnosed with tracheal defects were enrolled in the study,of whom 59 patients underwent sleeve resection followed by end-to-end anastomosis;40 patients received window resection alongside sternocleidomastoid(SCM)myoperiosteal flap reconstruction;five patients received converting defects with rotation anastomosis and two patients underwent modified tracheostomy with secondary stage flap reconstruction.Lumen stenosis occurred in three V 2H 1 defect cases and were treated by a second reconstruction surgery.Iatrogenic unilateral recurrent laryngeal nerve paralysis occurred in two patients with the V 3H 2 defect type,who were treated by temporary tracheotomy and partial vocal cord resection and extubated successfully during follow-up.All 106 patients achieved airway patency with adequate laryngeal function at the end of follow-up.No anastomotic dehiscence or bleeding occurred in any patient postoperatively.Conclusion:Though a significant number of multicenter studies concerning the reconstruction and classification of tracheal defects are needed,the study herein provides a novel classification of tracheal defects,which is primarily developed on the defect size.Therefore,the study might serve as a potential source for identifying suitable reconstruction strategies for practitioners.展开更多
文摘Objective： To study the possibility of using portions of deepithelialized myocutaneous flaps to the reconstruction of thoracic tracheal defects after resection of a large tumor. Methods： From June 2007 to June 2012, five cases of defects of the thoracic trachea were reconstructed by applying portions of deepithelialized myocutaneous flaps. The patients were 27-61 years old with 4 male cases and 1 female. The cervical trachea ranged in diameter from 4-8.5 cm with circumferences of approximately 1/3-2/5 of the bronchial circumference. Results： M1 five patients with thoracic tracheal defects after resection of a large tumor were cured of portions of deepithelialized myocutaneous flaps, with no tracheal stricture remaining and vomica successfully eliminated. During the first 1 to 3 months after the operation, bronchoscopy showed that the tracheal lumens were smooth, and the visible skin of the musculocutaneous flaps became gray and exhibited a small amount of white discharge. Conclusions： Despite this being a small series and short follow-up, this thoracic tracheal reconstruction with portions of deepithelialized myocutaneous flaps shows encouraging preliminary results and could be an alternative to other methods for the treatment of carefully selected patients with thoracic tracheal defects.
文摘To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum was used to reconstruct the tracheal defect when the blood supply to the ipsilateral sternocleidomastoideus was destroyed because of lymphonode clearing or radiotherapy.The pedicle of the musculo-periosteum flap was dissected adequately and the blood supply was protected carefully.Results All flaps survived with epithelization and osteogenesis.The endotracheal tubes were pulled out safely without trachea stenosis in all the patients.Conclusion The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum could reconstruct the tracheal defect when the ipsilateral blood supply was damaged.This method extends the application of the musculo-periosteum flap.3 refs,4 figs.
文摘Objective:The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies.Methods:The retrospective study was designed to analyze patients with diagnosed primary or secondary tracheal tumors from 1991 to 2020.Surgical techniques,complications and prognosis were reviewed.Airway status and patient outcomes were the principal follow-up measures.Tracheal defects were classified into two plane sizes(vertical(V)and horizontal(H)planes).Vertical defects were further categorized into three groups based on their tracheal ring numbers(V 1,≤5 rings;V 2,6-10 rings;and V 3,>10 rings).Tracheal defects with horizontal plane size H 1 and H 2 represent defects less and more than one-half the circumference of trachea.Thus,suitable reconstruction strategies were planned primarily based on"V"and"H"classifications.The reconstruction strategies performed were sleeve resection followed by an end-to-end anastomosis,window resection with sternocleidomastoid myoperiosteal flap reconstruction,defects conversion with rotation anastomosis,and modified tracheostomy with secondary flap reconstruction.Results:A total of 106 patients diagnosed with tracheal defects were enrolled in the study,of whom 59 patients underwent sleeve resection followed by end-to-end anastomosis;40 patients received window resection alongside sternocleidomastoid(SCM)myoperiosteal flap reconstruction;five patients received converting defects with rotation anastomosis and two patients underwent modified tracheostomy with secondary stage flap reconstruction.Lumen stenosis occurred in three V 2H 1 defect cases and were treated by a second reconstruction surgery.Iatrogenic unilateral recurrent laryngeal nerve paralysis occurred in two patients with the V 3H 2 defect type,who were treated by temporary tracheotomy and partial vocal cord resection and extubated successfully during follow-up.All 106 patients achieved airway patency with adequate laryngeal function at the end of follow-up.No anastomotic dehiscence or bleeding occurred in any patient postoperatively.Conclusion:Though a significant number of multicenter studies concerning the reconstruction and classification of tracheal defects are needed,the study herein provides a novel classification of tracheal defects,which is primarily developed on the defect size.Therefore,the study might serve as a potential source for identifying suitable reconstruction strategies for practitioners.
