Larynx reconstruction

First operation

 
The following is done during the first operation (Click on the links to view/hide the consecutive images).

a. Removal of the tumor with the neck nodes and 1 half of thyroid gland.

b. Extent of resection for lateralized glottic cancer.

c. Laryngeal defect after tumor removal.

d. A flap is taken at the forearm; it consists of :

° Subcutaneous tissue and fascia for tracheal wrapping (needed to give the trachea a new blood supply).
° Skin for temporary closure of the hemilaryngectomy defect.
° A vascular pedicle (blood vessels).

e. The forearm flap is transferred to the neck and the fascia flap is wrapped around the trachea (blue arrow) while the skin is sutured into the laryngeal defect (black arrow).

f. The blood vessels of the forearm flap are sutured to the neck vessels. A tracheostome (asterisk) is left between reconstructed larynx and fascia-enwrapped trachea. The fascia is wrapped around the trachea (arrow).

g. Frontal view of first operation:

1. Radial artery and vein are sutured to the neck vessels.
2. The skin flap is sutured into the laryngeal defect.
3. Fascia flap is wrapped around cervical trachea. A Gore-tex® membrane (white) is applied over the fascia to prevent adhesions.

 
View movie: Tumor resection - (Quicktime - 11 Mbytes) - Download Quicktime

What to expect after the first operation?

- The gastric tube is used for feeding during the first week. Usually, oral feeding can be started during the first week with the help of a speech-language pathologist.

- Breathing occurs through the ‘tracheostome’. A tracheostomy tube is placed into the stoma after the operation. However, this is usually done on a temporary basis until the stoma will stay open on its own.

- Speaking is possible during the first week. Speaking requires finger occlusion of the tracheostome during expiration. Total hospital stay after the first operation is about 8 days.

A scar is visible at the site of harvest of the forearm flap. A skin graft is applied to close the donor defect. The donor defect may look ugly in the beginning. The defect will however improve with time and will not result in functional sequellae for finger and hand movement.

 
View movie: A scar is visible at the site of harvest of the forearm flap (Quicktime - 300 Kbytes) - Get Quicktime

 
View movie: Function after the first operation. How does the patient breath and speak after the first operation? - (Quicktime - 5 Mbytes) - Download Quicktime