Abstract
Background The process of reconstruction of tracheal defects is complex and still not optimum.
Options range from using staged reconstructions, combining flaps with autologous or
alloplastic implants, as well as use of tissue-engineered constructs combined with
vascularized tissues which are lined with cell cultures. Staged reconstructions using
prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex
structure. Prefabricating the flap at a different site allows for integration of the
tissues prior to its transfer.
Method This article reports two patients planned for tracheal reconstruction for the purpose
of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction
using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was
performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated
with buccal mucosa, was performed. However, in the latter case, an intraoperative
decision by the head and neck team to limit excision of the trachea sparing the mucosa
was taken; the reconstruct in the forearm was redundant and needed to be discarded,
replacing the defect with a free superficial circumflex iliac artery perforator (SCIP)
flap.
Result At 3 years follow-up, both the patients are free of disease, with the construct serving
its purpose in the older female.
Keywords
tracheal reconstruction - prefabricated flap - prelaminated flap
