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Revascularized free pleuroperiosteal flap to correct full thickness tracheal defects.

R ECONSTRUCTION of the trachea following extensive resection remains a difficult surgical problem. Although numerous clinical and experimental procedures have been attempted and have been evaluated, none have been totally successful. Restoration of tracheal mucosa by autogenous or homologous soft tissue grafts has usually failed either because of rejection or tracheal obstruction secondary to formation of granulation tissue. Tracheal stenosis has also resulted following soft tissue grafting to repair large tracheal defects because of the absence of inherent rigidity. In an attempt to maintain patency of the lumen, various synthetic prostheses or homografts have been tried and found wanting. Present surgical management of tracheal defects has been restricted to small lesions where direct end-to-end anastomosis of the tracheal stumps can be performed according to the technique of Som' and Grillo.25 This preliminary report describes an experimental method to reconstruct large tracheal defects using autogenous grafts which provide mucosal continuity and maintain lumen patency.