Laryngeal repair after resection of advanced cancer: an optimal reconstructive protocol

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Abstract
Tracheal autotransplantation allows for reconstruction of extended hemilaryngectomy defects after resection of laryngeal cancer. With this technique, optimal functional results were obtained after a learning curve of more than 50 patients. The objective of this paper is to present the final reconstructive concept with the typical indications. Unilateral glottic cancer and lateralized chondrosarcomas of the cricoid cartilage are resected with a hemilaryngectomy including one-half of the cricoid cartilage. After tumor resection, a radial forearm flap with a skin paddle and a fascial paddle are taken. The skin paddle restores the laryngeal defect temporarily, and the fascial paddle wraps the upper 4 cm of cervical trachea. A 'tracheostomy' is preserved in the area between the reconstructed larynx and the fascia-wrapped trachea. The radial forearm vessels are sutured to the neck vessels. After 4 months, the skin island of the radial forearm flap is removed from the defect and the revascularized, fascial enwrapped trachea is transplanted to the laryngeal defect. The tracheal continuity is re-established with preservation of a tracheostoma. The tracheotomy can be closed after 6 weeks. Two case reports are presented: a unilateral T3 glottic cancer and a chondrosarcoma of the cricoid cartilage. The two patients showed normal oral feeding 1 week after the operation. Hand-free speaking was possible after closure of the tracheostomy. Tracheal autotransplantation after vascular induction of the trachea with the radial forearm flap leads to optimal repair of extended hemilaryngectomy defects.