MANAGEMENT OF TRACHEAL WALL RESECTION FOR THYROID-CARCINOMA BY TRACHEOCUTANEOUS FENESTRATION AND DELAYED CLOSURE USING AURICULAR CARTILAGE

Background. In the case of advanced thyroid carcinoma invading the tra chea, surgical procedures for tracheal resection are selected in relat ion to the degree of invasion. We created a tracheocutaneous fenestrat ion that was later closed with a free auricular cartilage autograft. W e present a simple and effective method for permanent closure of trach eostoma. Methods. The surgical procedure for delayed closure consists of three steps: (1) preparing the hinge flap with additional undermini ng of the subcutaneous layer and the strap muscles; (2) removing a por tion of the conchal cartilage from the auricle, which is easily perfor med with a semicircular skin incision along the anthelix of the ear; a nd (3) placing the conchal cartilage with its convex surface upward ju st over the sutured hinge flap layer. Results. Under local anesthesia, we successfully employed this reconstructive procedure for 5 patients . Unfortunately, however, in one patient, we had to reopen the closed tracheocutaneous fenestration on the second postoperative day because of an acute problem that was independent of the closure surgery. Four patients remain in satisfactory condition for more than 2 years since the closure of tracheostoma. Conclusions. The auricular cartilage free graft is a relatively simple procedure which supplies tracheal wall s keletal support for the permanent closure of the tracheocutaneous fene stration.