Reconstruction of Vertical Hemilaryngeal Defect using Vascularized Tracheal Cartilage with Pectoralis Major Flap
DOI:
https://doi.org/10.71321/cn58dp71Keywords:
Laryngotracheal stenosis, vertical partial laryngectomy defect , laryngotracheal reconstruction , vascularized tracheal cartilage, pectoralis major flapAbstract
Objectives: This study aims to explore the feasibility of utilizing tracheal cartilage vascularized with a pectoralis major muscle flap for the reconstruction of vertical hemilaryngeal defects and to provide an experimental foundation for such reconstructions.
Methods: Initially, the tracheal cartilages of nine Beagle canines were vascularized using pectoralis major muscle flaps. Subsequently, a defect model was established by vertically resecting the entire hemilarynx, and the vertical hemilaryngeal defect was reconstructed using the vascularized tracheal cartilage. Laryngeal computed tomography (CT) and video laryngoscopy were conducted at the following time points: pre-operation, immediately post-operation, and 28 days post-operation. At 28 days post-operation, the experimental dogs were euthanized after the completion of the examination. The reconstructed larynx was sectioned and subjected to hematoxylin and eosin (HE) staining.
Results: Eight dogs were successfully extubated and could consume normal food. Immediate postoperative video laryngoscopy indicated a well-sutured trachea, mucosa with normal color, and a restored and unobstructed laryngeal airway. Twenty-eight days post-operation, video laryngoscopy revealed a slightly edematous tracheal mucosa, a well-supported laryngeal cavity without collapse, routine healing of the tracheal suture, half-reconstruction of the laryngeal defect, and no obvious granulosis. Additionally, laryngeal CT demonstrated that the reconstructed laryngeal cavity was unobstructed and that the transplanted tracheal cartilage had maintained its position. Hematoxylin and eosin (HE) staining showed favorable survival of the pectoralis major composite flap and the transplanted tracheal cartilage.
Conclusion: This preliminary investigation demonstrates that short-term restoration of laryngeal structure and swallowing/respiratory function can be achieved through the reconstruction of vertical hemilaryngeal defects (including involvement of the unilateral cricoid cartilage) using tracheal cartilage vascularized with a pectoralis major flap.
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