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The usefulness of the IMAP propeller flap for trachea and tracheostome reconstruction after resection of parastomal recurrence of squamous cell carcinoma following salvage total laryngectomy

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Parastomal recurrence of squamous cell carcinoma (SCC) with tracheal involvement following salvage total laryngectomy after prior concurrent chemoradiotherapy is one of the most insidious challenges in head and neck surgery because a complex reconstruction is often required for covering a large area of skin loss, filling the dead space beneath, tracheal reconstruction and suspension, and tracheostome resurfacing. The aim is to describe our experience with the internal mammary artery perforator (IMAP) propeller flap for tracheal and tracheostome reconstruction and neck resurfacing after parastomal and cervical trachea resection, especially for suspension and anchoring the stump of the residual distal trachea to the island flap itself.

Methods

We describe IMAP flap reconstruction after resection of parastomal recurrence of SCC requiring cervical trachea resection in five patients between January 1, 2005 and August 30, 2019.

Results

IMAP propeller flap was successfully used for reconstruction after complex resection of parastomal recurrence of SCC with cervical trachea involvement in all cases. The mean length and width were, respectively, 16.8 cm (range 13–23) and 6.9 cm (range 5.5–8). We did not report complications of both the donor and the recipient site. Pharyngo-cutaneous or tracheoesophageal fistulas and wound dehiscence were not observed.

Conclusions

to the best of our knowledge, this is the first report about the use of the IMAP propeller flap in this more complex clinical setting and we provide the message that this surgical procedure is worthy of consideration.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Head and Neck Surgical Oncologic Unit - Otorhinolaryngology, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Largo A. Gemelli n.8, 00168, Rome, Italy

    Giovanni Almadori, Giovanni Di Cintio, Eugenio De Corso, Dario Antonio Mele, Stefano Settimi & Gaetano Paludetti

  2. Institute of Plastic Reconstructive and Aesthetic Surgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy

    Aurora Almadori, Giuseppe Visconti & Marzia Salgarello

  3. Radiology and Neuroradiology Unit, Department of Diagnostic Imaging, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy

    Alessandro Cina

Authors
  1. Giovanni Almadori
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  2. Giovanni Di Cintio
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  3. Eugenio De Corso
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  4. Dario Antonio Mele
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  5. Stefano Settimi
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  6. Aurora Almadori
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  7. Alessandro Cina
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  8. Giuseppe Visconti
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  9. Gaetano Paludetti
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  10. Marzia Salgarello
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Corresponding author

Correspondence to Eugenio De Corso.

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Conflict of interest

The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethics approval

The study was approved by the institutional ethical committee review board with the following number of protocol: 0028911/19.

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Cite this article

Almadori, G., Di Cintio, G., De Corso, E. et al. The usefulness of the IMAP propeller flap for trachea and tracheostome reconstruction after resection of parastomal recurrence of squamous cell carcinoma following salvage total laryngectomy. Eur Arch Otorhinolaryngol 278, 499–507 (2021). https://doi.org/10.1007/s00405-020-06168-4

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  • DOI: https://doi.org/10.1007/s00405-020-06168-4

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