Design of a new technique using a free tracheal autologous graft for reconstruction of the cricoid cartilage and trachea.

PURPOSE: We devised a new operative procedure to recreate a supporting framework using a free tracheal autologous graft for cricoidal and tracheal defects. METHODS: We used this new transplantation method to repair the airway defect in five patients who underwent total thyroidectomy with resection of the airway for advanced thyroid cancer. A free graft was taken from the anterior aspect of the trachea and placed over the defect. The surface of the transplanted graft was then surrounded by the adjoining muscle flap. The orifice created by taking the graft was used as a temporary tracheostomy during the early postoperative period. RESULTS: Fiberscopic examinations and computed tomography scans done over 3-7 years postoperatively showed no airway deformity, subglottic stenosis, graft necrosis, or local recurrence in any of the five patients. The tracheal stoma closed spontaneously within 5 months after the operation in three of the five patients. CONCLUSION: The advantages of this procedure are: the free tracheal graft has as much strength as a prosthesis to support the respiratory tract; the autologous graft is biologically compatible; and the procedure can be completed in one surgical field and adopted for primary and secondary repair of the tracheal defect.

New surgical technique for primary and secondary voice restoration using a free ileocecal patch graft after total laryngectomy.

PURPOSE: We devised a new surgical technique to restore the voice after laryngectomy. This procedure is designed to repair the hypopharyngeal defect by using a free ileocecal patch for voice rehabilitation. METHODS: We performed this procedure in seven patients; for primary voice restoration in six and for secondary voice restoration in one. The technique involved resecting an ileocecal segment containing the ileocecal valve and cutting a patch from the cecum, the size of which was equalized with the hypopharyngeal defect. After patch repair of the defect, the tracheopharyngeal shunt was completed by an anastomosis between the ileum and trachea. RESULTS: One patient died from sudden rupture of the carotid artery, but all six survivors were able to speak and swallow without aspiration, achieving fair to good articulation. CONCLUSIONS: The advantages of our method are as follows. (1) The operative procedure is simple and does not require complicated remodeling of the intestinal graft for voice production. (2) The ileocecal valve can prevent aspiration. (3) The patch expands the pharynx and prevents narrowing. (4) Using this procedure, it is possible to achieve voice restoration even in patients who have undergone total laryngectomy in the past.