Comparison of different methods of circumferential tracheal reconstruction: an experimental study.

OBJECTIVES: This study was designed to compare different prefabrication models for circumferential tracheal reconstruction. MATERIALS AND METHODS: Thirty adult female New Zealand rabbits were divided into six groups for circumferential tracheal reconstruction with a different tissue combination. Prefabrication of neotrachea was performed without anastomosis. Lateral thoracic fascia or pectoralis major muscle were used for vascular supply. Polypropylene mesh, polytetrafluoroethylene (Gore-Tex), or cartilage rings were used for skeletal framework. Hairless epithelial skin graft was used for inner lining. The groups were compared in terms of viability of hairless epithelial graft, longitudinal flexibility, rigidity, flap wall thickness, internal diameter, and flap viability. RESULTS: Epithelial skin graft was almost totally viable (95%-99%) in the polypropylene mesh groups. Gore-Tex groups exhibited almost total necrosis (74%-71%). Longitudinal flexibility and rigidity were similar to the native trachea in Gore-Tex and polypropylene mesh groups. Neotrachea prefabricated with cartilage grafts showed more than normal longitudinal flexibility and collapsed easily. CONCLUSION: The prefabricated model with the use of polypropylene mesh for skeletal framework and lateral thoracic fascia for vascular supply seems to be the best alternative in the reconstruction of circumferential tracheal defects.

Sculpturing a fibular flap: combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap.

A fibular flap has great versatility in reconstructive procedures. Osteomies and ostectomies enable the flap to be used for variable defects. We used combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap in two patients. Vertical osteotomy transforms the tubular structure of a fibula into a flat bone that can be used for reconstruction of wider defects with less vertical height. Neither vertical osteotomy nor ostectomy had negative effects on viability and bony healing of the segments in our patients. We think that the fibular flap, thanks to its versatility, can be used for reconstruction of complex orbito-zygomatic and orbito-cranial defects successfully.