(504) Tracheal Reconstruction with Pre-Fabricated Radial Forearm Flap with Vascularized Cartilage

Introduction: Tracheal reconstruction may be indicated for management of tracheal stenosis or tracheal fistulas. Auricular cartilage grafts have been previously utilized for laryngo-tracheal reconstruction. Large tracheal defects may require a vascularized cartilage graft for optimal healing and to reduce the risk of cartilage reabsorption.

Methods: We present a case series of patients who underwent tracheal reconstruction utilizing a pre-fabricated radial forearm flap with vascularized auricular cartilage graft in the past 15 years.

Results: Patient 1 presented with a tracheoesophageal fistula measuring 1.4 cm due to erosion from cervical hardware, requiring reconstruction of the posterior tracheal wall. Patient 2 developed a 5 cm segment of tracheal stenosis with significant scarring and had the anterior tracheal wall reconstructed. Patient 3 developed a large 4 cm tracheocutaneous fistula following a tracheotomy for mechanical ventilation during her severe COVID-19 infection. The anterior tracheal wall and fistula was closed using the prefabricated flap.

Reconstruction is performed in a two-stage manner. The initial stage involves harvesting auricular conchal cartilage and inserting it into the future radial forearm fasciocutaneous flap to allow for vascular integration. The second stage involves elevating and transferring the composite radial forearm flap to reconstruct the tracheal wall defect and add a layer of vascularized tissue during the closure.

Conclusions: This poster will describe the details of the two-stage reconstruction and outcome with photo documentation to demonstrate this novel technique for tracheal reconstruction.