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J Thorac Cardiovasc Surg 2003;126:545-550
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Reconstruction of the trachea with a tubed radial forearm free flap

B. R. Beldholm, MBBS, BSc(Med)a,*, M. K. Wilson, MBBS, BSc(Med), FRACSa, R. M. Gallagher, MBBS, FRACSb, D. Caminer, MBBS, FRACSc, M. J. King, MBBS, FFARCSd, A. Glanville, MD, FRACPe

a Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, Australia
b Department of Otolaryngology—Head and Neck Surgery, St Vincent’s Hospital, Sydney, Australia
c Department of Plastic and Reconstructive Surgery, St Vincent’s Hospital, Sydney, Australia
d Anaesthetics, St Vincent’s Hospital, Sydney, Australia
e Thoracic Medicine, St Vincent’s Hospital, Sydney, Australia

Received for publication January 4, 2003; accepted for publication January 22, 2003.

* Address for reprints: Dr Bernard Richard Beldholm, St Vincent’s Hospital, PO Box 689, Miranda NSW 1490, Australia
Beldholm{at}yahoo.com

BACKGROUND: We present the case of a patient with adenoid cystic carcinoma of the trachea who had 60 mm of the trachea excised and reconstructed with a stented radial forearm free flap. The patient was well in the immediate postoperative period with good function of the neotrachea. Problems developing after the reconstruction included proximal stricture, sputum retention, and recurrent pneumonia.

RESULT: The patient died of malignant hypercalcemia 16 months after the reconstruction. To our knowledge this is the first reported case of a total tracheal resection and reconstruction with a combination of free tissue transfer and internal stenting.

CONCLUSION: We conclude that tracheal reconstruction has the potential to provide a reliable airway in patients not able to be reconstructed with a primary anastomosis.




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