TRACHEOPLASTY USING TITANIUM RECONSTRUCTIVE PLATES WITH STRAP-MUSCLE FLAP

The reasons for unsuccessful decannulation after a laryngotracheoplast y may be multifactorial depending on the techniques used. Excessive gr anulation tissue may develop, necessitating further adjunctive procedu res. Cartilaginous grafts may get infected; resorb, or collapse;into t he tracheal lumen. Bulky regional skin-muscle flaps may dehisce under tension or collapse into the tracheal lumen. Medial migration of the s plit ends of the anterior cartilaginous tracheal rings ensues with sub sequent restenosis. Donor-site morbidity may compound these problems a s well. During a 2.5-year period, we have performed laryngotracheoplas ty on nine patients with 60% to 100% tracheal stenosis using titanium reconstruction plates. The split anterior tracheal wall is fixed by th e plates in its expanded position. A neurovascularized strap-muscle fl ap is used to reconstruct the anterior tracheal wall. The flap becomes epithelialized with squamous epithelium within 3 weeks. Successful de cannulation was possible in seven of the nine (78%) patients with no f urther respiratory problems. Of these, six required no further procedu res. This technique offers a viable simple alternative to other method s of laryngotracheoplasty without the need for donor cartilage grafts or thick bulky skin-muscle flaps.