Long-Segment Tracheal Stenosis Treated with Vascularized Mucosa and Short-Term Stenting Steven Stamenkovic, MD, Robert Hierner, MD, PhD, Paul De Leyn,

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Long-Segment Tracheal Stenosis Treated with Vascularized Mucosa and Short-Term Stenting Steven Stamenkovic, MD, Robert Hierner, MD, PhD, Paul De Leyn, MD, PhD, Pierre Delaere, MD, PhD The Annals of Thoracic Surgery Volume 83, Issue 3, Pages 1213-1215 (March 2007) DOI: 10.1016/j.athoracsur.2006.04.027 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Mucosa-lined fascia flap. A full-thickness mucosal graft measuring 1 × 2.5 cm is taken at the left and right buccal area and sutured (arrow) to the subcutaneous tissue of a radial forearm flap (Vicryl 5.0). A mucosa-lined area of 1 × 5 cm is obtained. After mucosal grafting, the fascia flap is dissected based on the radial artery and vein. The distal skin paddle (asterisk) will serve as a flap monitor. The donor defect can usually be closed without using a skin graft. The Annals of Thoracic Surgery 2007 83, 1213-1215DOI: (10.1016/j.athoracsur.2006.04.027) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Surgery for long-segment stenosis. (A) Stenosis located in subglottic area with extension into cervical trachea. Length of stenosis: 6 cm (A2) Dumon (Novatech, Aubagne, France) stent with diameter of 12 mm (A1, double arrow) and length of 6 cm has been placed. The stenosis is incised longitudinally (A1, double arrow) and expanded (A1, dotted arrow). (B) A Dumon stent with a diameter of 16 mm (B1, dotted arrow) and a length of 5 cm is inserted in the expanded airway (B2). The anterior defect is reconstructed with the mucosa-lined fascia. The stent supports the reconstruction. A tracheostomy is placed below the reconstruction. The distal skin flap is exteriorized and serves as a monitor for the viability of the flap. (C) Situation after stent removal and before closure of the tracheostomy (C2). The mucosa-lined forearm flap repairs the airway anteriorly. The Annals of Thoracic Surgery 2007 83, 1213-1215DOI: (10.1016/j.athoracsur.2006.04.027) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Computed tomographic scan of long-segment stenosis. (A) Coronal view before reconstruction. A Dumon stent (between white arrows) with a diameter of 12 mm and a length of 6 cm preserves the airway. The stenosis is incised longitudinally (double arrow). The axial computed tomographic (CT) scans B, C, D are taken at the same level (white line) before and after reconstruction. (B) Axial CT scan before reconstruction with the stent in place. (C) Axial CT scan after reconstruction with the stent in place. (D) Axial CT scan after reconstruction and after stent removal. Double arrow shows luminal concavity after excision and expansion of stenosis. Mucosa-lined fascia repairs the defect linearly. Asterisk indicates fascia flap. The Annals of Thoracic Surgery 2007 83, 1213-1215DOI: (10.1016/j.athoracsur.2006.04.027) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions