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. 2020 Nov 25;20(1):299.
doi: 10.1186/s12893-020-00972-9.

Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

Di Deng  1 , Feng Xu  1 , Jifeng Liu  1 , Bo Li  1 , Linke Li  1 , Jun Liu  2 , Fei Chen  3
Affiliations

Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction

Di Deng et al. BMC Surg. .

Abstract

Background: Large or complex trachea defects often require some tissue to reconstruct, various flaps have been reported for reconstructing this defect. However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction. Therefore, this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction.

Methods: Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed.

Results: All of the pedicled TAAP flaps in our study survived. The flap size ranged from 2 cm × 5 cm to 4 cm × 10 cm, and the size of each island of one double-island flap was 2 cm × 2.5 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities, such as diabetes, hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis. Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment.

Conclusion: Pedicled TAAP flaps provide a short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

Keywords: 2-stage; Double-island flap; Pedicled thoracoacromial artery perforator flap; Thyroid carcinoma; Tracheal reconstruction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Design of pedicled thoracoacromial artery perforator flap for tracheal reconstruction
Fig. 2
Fig. 2
Reconstruction process. a The flap was designed according to the size of tracheal defect. b Flap has been elevated to defect through a tunnel under the clavicle. c, d The flap was sutured to the trachea and neck skin as for a permanent tracheostomy
Fig. 3
Fig. 3
Double-island pedicled TAAP flap was used in tracheoesophageal fistula. a Tracheoesophageal fistula. The red arrow indicates the stomach tube, the green arrow indicates the tracheal catheter, the blue arrow indicates the flap of previous surgery. b Flap was sliced into two parts from the skin layer to be a double-island flap
Fig. 4
Fig. 4
Postoperative follow-up. a The TAAP flap was in good condition (black arrow) under direct vision after the first stage tracheal reconstruction. b The donor site was well after operation. c, d CT showed the trachea after the second stage tracheal reconstruction with a local flap. The blue and red arrow indicates the pedicled TAAP flap, the green arrow indicates the local flap
See this image and copyright information in PMC

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