陳旧性喉頭気管狭窄に対する一期的再建術の一新法

抄録

The treatment for late cases that showed stenosis of the larynx and trachea is troublesome and usually requires a long time and the perseverance of both patients and doctors to be cured.
We deviced an operation designed to produce a one stage cure:
1. The scar tissue of the stenosis area is resected.
2. To reconstruct the inner lining of the lumen, the island pedicle neck flap is inserted.
3. To insure the stable structural framework, the cartilage of the rib is usually used.
4. The stent is inserted into the lumen by using a finger cot, filled with silicon sponge, to maintain an adequate airway for about four weeks.
5. The external covering is done by direct closure or a rotated neck flap.
6. Tracheostoma should remain open for four to six months.
In seven cases, all obtained satisfactory results for airway by this method.
We were concerned at first about the occurrance of necrosis of the flap and the cartilage. However, our experience with hemilaryngectomy (Conley) indicates that the cervical flap is the appropriate choice in these cases. We also believed in the stability of transplanted cartilage and therefore were confident in doing these operations.
When this operation is done very carefully, with special attention given to treatment of the flaps, it is possible to complete the reconstruction in a short period.