Reconstruction Of The Hemilarynx After Hemilaryngectomy For Unilateral Advanced Larynx Tumors. The Learning Curve After 100 Cases Of Hemilaryngeal Reconstruction By A Prefabricated Trachea.
Ernest Schouppe, MD, Jan Jeroen Vranckx, MD,PhD, Jeroen Meulemans, MD, Thomas Nevens, MD, Pierre Delaere, MD,PhD.
KUL Leuven University Hospitals, Leuven, Belgium.
PURPOSE: A unilateral advanced tumor on one vocal fold usually is treated by total laryngectomy since the reconstruction of a hemilarynx for sparing one vocal cord is so complex. However, every attempt must be made to avoid total laryngectomy since the loss of speech and the need of a permanent tracheostome dramatically change quality of life of those patients. METHODS: We present our conventional and modified protocol of hemi-larynx reconstruction using a prefabricated trachea segment since trachea has a similar hollow fibrocartilaginous structure, lined with respiratory epithelium (n=100).
RESULTS: In the initial 2-stage protocol we first prefabricated the caudally positioned trachea before tumor resection of the hemilarynx. The trachea does not have an axial vascular pedicle that allows mobilization as a pedicled flap.In the 2nd stage we use the prefabricated trachea to close the hemilarynx defect after tumor resection. However, this protocol may lead to tumor spilling and recurrence.
In actual protocol we resect the hemilarynx tumor in 1st stage and temporarily close the resulting defect with a 2-unit radial forearm free flap: a fascia segment serves to prefabricate the later donor trachea segment and the fasciocutaneous segment closes the actual hemlilarynx defect on a temporary tracheostome. In 2nd stage, we restore the hemilarynx defect with the prefabricated trachea sparing one vocal cord. The tracheostome is removed. CONCLUSION: The combined use of the tracheal autotransplant with the radial forearm flap approaches the desired optimal reconstructive morphology after repair of extended hemilaryngectomy defects and prevents a total laryngectomy in selected cases.
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