Cricotracheal Reconstruction with a Pre-laminated Free Flap for Voice Restoration
Jenna Bergman MD
University of South Florida
Jenna Bergman, MD
Background: Reconstruction of large laryngotracheal defects remains a surgical challenge. Rebuilding the airway with rigid, vascularized tissue is optimal to restore function and prevent stenosis. We describe a two-staged reconstruction method for a large laryngotracheal defect using a pre-laminated free flap.
Methods: A 58 year-old male with a history of prolonged intubation and complete tracheal stenosis just below the vocal cords secondary to cricotracheal separation, presented to our clinic with the hope of regaining his natural voice. The first stage of reconstruction consisted of harvesting rib cartilage and implantation of the graft into the right anterolateral thigh. Approximately 2 months later, the patient underwent cricotracheal resection and right sided anterolateral thigh free flap with placement of the pre-laminated rib cartilage into the cricotracheal defect. A t-tube was placed as a stent inferior to the vocal cords to facilitate rigid structure and patency.
Results: Approximately 6 weeks following reconstruction, the t-tube stent was removed, and the patient’s tracheostomy tube was replaced with a t-tube. The patient was immediately able to phonate.
Conclusion: Pre-laminated free flaps using rib cartilage are an effective option for functional restoration of cricotracheal defects. This two-stage approach allows for complex tracheal defects to be replaced with vascular and rigid tissue that withstands airway pressure and prevents recurrent stenosis.
To describe an operative technique for the purposes of restoring voice in patients with large laryngotracheal defects.
To demonstrate the utility of pre-laminated free flaps using rib cartilage for functional restoration of cricotracheal defects.
To discuss the patient population who would benefit from a pre-laminated free flap for tracheal reconstruction.