Laryngeal scarring strictureplasty

Transplantation of full-thickness skin flaps is a more effective measure for cases of severe laryngeal scar stenosis or failure of laryngeal fissure opening. After the full-thickness skin graft is surviving, it is less contracted, but it is difficult to survive. After the resection of the laryngeal scar, there is only a residual cartilage scaffold and peripheral mucosa in the cavity. The blood supply is very poor, and it is difficult to fix. Use a pedicle flap or a skin tube to facilitate the survival of the whole skin. Treating diseases: throat stenosis Indication More severe stenosis of the throat. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation Neck radiograph. Surgical procedure (A) flap formation: surgery is completed in two phases. The first phase: After the stenosis of the stenosis is removed by laryngeal rupture, the area of the wound is correctly estimated, and the length and width of the desired flap are marked with methylene blue or nail purple in the neck. The position of the pedicle should be close to the same level as the desired graft, and as close as possible to the midline to shorten the length of the flap (the tip of the flap is prone to necrosis). The flap is transferred into the laryngeal cavity, evenly spread on the wound surface, and the periphery and the mucosa are intermittently sutured, and the hemostasis of the wound should be completely thorough, so as to avoid the formation of hematoma under the flap and affect survival. Due to coughing, the flap is easily picked up by the airflow and should be pressed and fixed. Usually, the silicone flap can be used to place the flap in the laryngeal cavity, and the silicone tube is opened with a small hole, which is made of stainless steel wire, and is fixed to the skin of the neck through the type opening. Note that the diameter of the silicone tube should match the inner diameter of the throat; too much pressure can cause the flap to be necrotic. If it is too small, it can not be pressed and fixed. The laryngeal opening is not sutured. The wound surface for the flap is not more than 3.5 to 4.0 cm in width, and can be sutured by tension after separating and relaxing the subcutaneous tissue on both sides. If the wound has more scars, the thigh should be repaired. Phase 2: After 2 weeks, reopen the larynx, remove the silicone tube, and check the flap survival. If the survival is good, the pedicle of the flap is cut, and after being turned over, the wound is sutured with the contralateral side to form a laryngeal cavity. At this point, the tracheal cannula can be blocked with a finger to check if the patient is well ventilated. Generally, there should be no difficulty breathing or improvement. In order to prevent re-stenosis, the silicone tube may not be removed during the second operation, and the mouth is removed after 2 to 3 months. However, if the silicone tube is placed too long, it may cause the transplanted skin to smash and necrosis. Therefore, if the throat cavity is wide enough, the silicone tube can no longer be placed. (B) skin tube formation: due to trauma or multiple operations, the area of the scar near the midline of the neck is often large, which makes the pedicle of the flap far from the midline, the flap is often too long, affecting survival after transplantation. To ensure the survival of the transplanted skin, a skin tube can be made. In the first operation, according to the clinical examination and X-ray film, the required skin piece is planned, and the skin tube is made into the neck. The skin wound should be sutured or the inner thigh slice should be repaired. After 2 weeks, the skin should be repaired. The second phase of surgery. The second stage of the operation is similar to the first stage of flap formation, that is, the lower end of the skin tube is broken off, the skin tube is cut according to the length required for the transplanted wound, slightly thinned, transplanted into the laryngeal cavity, and the silicone tube is pressed and fixed. . The third operation was performed after about 2 weeks, and the operation was the same as the second stage of flap formation. complication Postoperative bleeding.