Larynx reconstruction

Second operation

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

a. Removal of the skin flap from the defect. A small amount of skin is preserved superiorly (asterix). The removed skin flap is de-epithelialized (lined area). The trachea is mobilized with preservation of its new blood supply. The trachea is transplanted to the defect (arrows). The mediastinal trachea is sutured to the reconstructed larynx.

b. A tracheostome (asterix) is left below the reconstructed larynx.

What to expect after the second operation?

- The gastric tube is used for feeding during 2-3 days. Oral feeding can be started during the first week.

- Breathing occurs through the mouth and the nose. The ‘tracheostome’ is preserved as a safety measure after tracheal autotransplantation. A tracheostomy tube is placed into the stoma after the operation for the first postoperative day.

- Speaking is possible after 1 day. Speaking requires finger occlusion of the tracheostome during expiration. Total hospital stay after the second operation is about 7 days.

Why does it take 2 to 3 months between the first and second operation?

- The definitive reconstruction can be done in a better and safer way after 2 to 3 months.
- It is important to be sure that no tumor remains before the definitive reconstruction with the trachea is done. After 2-3 months, the defect margins can be re-evaluated and a recurrent tumor can be ruled out.