V skin flap in the treatment of tracheostomal stenosis following total laryngectomy

The surgical technique used to correct tracheostomal stenosis, following total laryngectomy, is based on the principles of elliptic skin incision; complete resection of the scar tissue responsible for the stenosis; beveled section of the trachea; reduced tension and appropriate coaptation on skin - tracheal suture; and placement of a V skin flap, by Y - V advancement or rotation, into the posterior tracheal wall. The purpose of the V flap placement is to increase the tracheal stoma circumference and redirect the circular scar contracture converting a circular scar to one of irregular contour, reducing the chances of restenosis. This prospective study presents the results of this technique in 14 patients with tracheostomal stenosis, treated from 1980 to 1996. Results from this technique have been gratifying. The tracheostome maintains stable size immediately following reconstruction, tracheal cannula is not required and does not demonstrate restenosis over extended followup periods, with a minimum 2 - year follow-up. This technique is simpler, has low morbidity, and is adaptable to any stenosed stoma configuration, as well as tracheostome construction during total laryngectomy. Radiotherapy, either pre or post tracheostome reconstruction, does not affected the viability of the V skin flap.