plastische, reconstructieve en esthetische chirurgie - UZ Leuven

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necessary and that there is no need for prolongedendotracheal intubation. Augmentation of the tracheallumen by inserting local, regional, or distant tissue isnecessary when a tracheal resection is not possible as,for example, in long-segment stenosis or in cases ofrestenosis after tracheal resection. Trachealreconstruction by using repair tissue is a second choicesolution because the optimal repair tissue is notavailable. The most frequently used reconstructivetissues consist of cartilage grafts, pericardium, andmuscle flaps (used as a carrier for skin, periosteum, orbone). Results obtained with these reconstructive tissuesare not constant because they all lack one or morerequirements for optimal tracheal repair. Experimentalevaluation showed that optimal laryngotracheal repairshould resemble the native tracheal tissue as closely aspossible and be composed of a cartilaginous support, aninternal lining consisting of respiratory mucosa, and areliable blood supply. These tissue characteristics maybe found in revascularized tracheal allo- and autografts.Tracheal allo- and autotransplants are, however, notavailable when dealing with tracheal restenosis or longsegmentstenosis.In previous animal experiments, we looked forautologous tissue matching the optimal tissue as closelyas possible. Composite tissue consisting of vascularizedfascia (blood supply), buccal mucosa (internal lining),and elastic cartilage (support) was found to closelymatch vascularized tracheal transplants. Flapprefabrication was, however, a requirement to allow forhealing of the cartilage component because barecartilage underwent necrosis when directly exposed tothe airway lumen. Composite tissue consisting ofvascularized fascia and mucosa could be used in a onestageprocedure. Vascularized mucosa can repair airwaydefects with primary healing of the reconstructed site.Expansion of the airway lumen will be less pronouncedbecause the cartilaginous supportive component is notavailable. Although support is not available, vascularizedfascia lined with buccal mucosa can succeed in solvingdifficult to treat airway stenosis. It is used here incombination with short-term airway stenting and isillustrated in a case of restenosis after segmentalresection.DELAERE P., VANDER POORTEN V., VRANCKX J.,HIERNER R.: Laryngeal repair after resection of advancedcancer: an optimal reconstructive protocol. Eur. Arch.Otorhinolaryngol., 2005; 262(11): 910-916.Tracheal autotransplantation allows for reconstruction ofextended hemilaryngectomy defects after resection oflaryngeal cancer. With this technique, optimal functionalresults were obtained after a learning curve of more than50 patients. The objective of this paper is to present thefinal reconstructive concept with the typical indications.
Unilateral glottic cancer and lateralizedchondrosarcomas of the cricoid cartilage are resectedwith a hemilaryngectomy including one-half of the cricoidcartilage. After tumor resection, a radial forearm flap witha skin paddle and a fascial paddle are taken. The skinpaddle restores the laryngeal defect temporarily, and thefascial paddle wraps the upper 4 cm of cervical trachea.A 'tracheostomy' is preserved in the area between thereconstructed larynx and the fascia-wrapped trachea.The radial forearm vessels are sutured to the neckvessels. After 4 months, the skin island of the radialforearm flap is removed from the defect and therevascularized, fascial enwrapped trachea istransplanted to the laryngeal defect. The trachealcontinuity is re-established with preservation of atracheostoma. The tracheotomy can be closed after 6weeks. Two case reports are presented: a unilateral T3glottic cancer and a chondrosarcoma of the cricoidcartilage. The two patients showed normal oral feeding 1week after the operation. Hand-free speaking waspossible after closure of the tracheostomy. Trachealautotransplantation after vascular induction of thetrachea with the radial forearm flap leads to optimalrepair of extended hemilaryngectomy defects.HIERNER R.: Operative treatment of pressure sores: howand when? J. Wound Healing, 2005; 10: 110-123.Pressure sores still presents a challenging problem ofdiagnosis and choice of treatment. Nowadays defectclosure alone is not sufficient to fulfil the criteria ofsuccessful defect reconstruction, which are as follows: 1)complete wound closure, 2) persistent wound closure, 3)functional reconstruction allowing early mobilization, 4)acceptable length of time for rehabilitation (and return tonormal life), and to a lesser degree 5) acceptableesthetic result. Successful treatment requires a globaltherapy concept based upon: 1) basic (plastic) surgicalprinciples, 2) defect-related factors, 3)- therapy relatedfactors, and 4) patient-related factors. The global therapyconcept is delivered by a multidisciplinary therapy-team(surgeon, nurse staff, physiotherapist, occupationaltherapist, social service...).HIERNER R., BECKER M., BERGER A.: Indications andresults of operative treatment in birth-related brachialplexus injuries. Handchir. Mikrochir. Plast. Chir., 2005; 37:323-331.Introduction: A review of the literature reveals that underconventional treatment alone or in combination withsecondary muscle/tendon transfer about 4 to 43% ofcases show incomplete recovery with severe functionaland/or aesthetic impairment. If those patients underwentearly microsurgical brachial plexus revision aregeneration without any significant functional and/or
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plastische, reconstructieve en esthetische chirurgie - UZ Leuven

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