Otolaryngology: Open Access
Open Access

Abstract

Introduction and Purpose: Reconstructions of the trachea are becoming a new challenge for Plastic Surgeons. Especially long defects, located intrathoracically, has rarely been reported. In an emergency situation no preoperative measures can be taken, and the technique applied must guarantee survival as well as function. Patient and method: Surgery (7. January 1980) was successful for a 38-year-old woman when infection of the neck after goiter resection had entailed complete sloughing of the trachea from the larynx (cricoid included) down to 2 cm above the carina. After necrectomy via the thoracical aperture, the trachea could be built up to the jugulum with two pedicled deltopectoral skin flaps shaped into a tube and supported by half-ring rib cartilages grafts. Without thoracotomy, surgery was extremely difficult. Ten years later reconstruction proceeded from the stoma toward the cricoid. using the upper parts of the flaps and cartilage. The patient gained full respiratory and speech rehabilitation. (inspite of a bilateral palsy of the recurrent nerve)A car accident in 2008 caused a severe trauma of the thoracic wall with fracture of the sternum and partial lesion of the artificial trachea, which could be repaired successfully again by implanting cartilage for support. Due to the missing specific epithelium, expectoration sometimes was a nuisance, e.g. when the patient suffered from bronchitis. To overcome this obstacle, a general surgeon implanted a stent. As was to be expected, the foreign body caused severe infection and had to be removed through a new tracheotomy, which she has to tolerate. In 2011 she had to undergo major heart surgery; her neotrachea coped with the �three-vessel bypass� intervention excellently. Results: Full function has been restored in spite of all problems. Conclusion: To solve such a severe acute problem it seems that the application of this known flap, described by Bakanjiam (many times used for Reconstructions by myself) as a new application�s method is superior to all other techniques developed so far. According to literature, a similar case was never reported before. In the history of medicine no human being has ever survived a complete destruction of the trachea!.

Biography

Hans Anderl, born 7.9.1930 in F?gen,Austria,Study: Innsbruck and Vienna.Medical degree 1957. Training of Gen.Surgery, MaxillofacialSurg. and Plast. Surgery(FRCS)Starting Plast.Surg. 1965 with Prof.Wilflingseder(First Chair of Plast Surg) Innsbruck.,East Grinstead and several other centers in G.B.,(one year) 6 months in the USA, Docent for PRS 1974, Prof.1976.Visiting Prof. to many Centers of PRS. all over the world. Head of the Departement, 1986, Retired 1998. Worked in the following fields of PRS: Burns: Primary Excision since 1969. Microsurgery: since 1968: Peripheral Nerverepair: incl. Facial Palsy(CrossfaceNerve Transplantation 1970),Brachial Plexus Lesions, Replantation Surgery, Free Tisssue Transfer, Handsurgery, Cleftlip and Palate Treatment, Primary Repair of the Nose in the Unilateral Cleft(Originator) Craniofacial Surgery: First Center in Austria since 1978. Early Member of the Int. Society of CraniofacialSurg.,Major Contributions in General Plastic Surgery. Other Activities: Founding Member and Honorary Member of many Int.Societies. (e.g.EURAPS) 160 Publications. Maliniac Lecture 1998 (Americ.Sociaty of PRS. with standing ovation).