PMC6358393_01
Preoperative PET-CT scan showing tumor with the cricoids cartilage and prelaryngeal skin invasion.
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F1
A PET-CT of the whole body showed extralaryngeal extension of the tumor invading the cricoids cartilage and prelaryngeal ribbon muscles and skin (see Fig. 1).
Tumor resection. A: Surgical incision design. B: Tumor resection. The red arrow indicates the neck infection fistula, the yellow arrow indicates the first tracheal cartilage, the blue arrow indicates the Inter-arytenoid region and the green arrow indicates the epiglottic cartilage.
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F2
As shown in Figure 2, the tumor was removed completely, together with thyroid cartilage, anterior half of cricoid cartilage, bilateral vocal cord, bilateral ventricular bands, bilateral laryngeal ventricle, part of the epiglottis, prelaryngeal ribbon muscles, and skin.
Harvesting of the free bipaddled anterolateral thigh (ALT) flap. A: Design of the bipaddled ALT flap. B: Exposure of the facsicoutaneous perforators from the descending branch of the lateral circumflex femoral artery. C: Harvesting of the ALT flap. D: Harvesting of the bipaddled ALT flap. The yellow arrow indicates the facsicoutaneous perforators from the descending branch of the lateral circumflex femoral artery. ALT = anterolateral thigh.
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F3
To simultaneously repair the defects of the larynx and prelaryngeal skin, a free bipaddled ALT flap was harvested as shown in Figure 3.
Simultaneous reconstruction of large larynx and prelaryngeal skin defects with the free bipaddled anterolateral thigh (ALT) flap. A and B: The reconstruction of the larynx defect with the smaller flap from the free bipaddled ALT flap. C. Microvascular anastomosis. D: The reconstruction of the prelaryngeal skin defects with the larger flap from the larger flap from the free bipaddled ALT flap. The blue arrow indicate the residual laryngeal structure, the green arrow indicates the smaller flap from the free bipaddled ALT flap, the yellow arrow indicates the larger flap from the free bipaddled ALT flap, and the purple arrow indicates the anastomosed vessel. ALT = anterolateral thigh.
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Figure 4, the smaller flap was initially sutured to the residual laryngeal mucosa, followed by microvascular anastomosis, during which 1 artery and 2 veins were anastomosed. Finally, the larger flap was sutured to the cervical skin.
Postoperative MRI and CT scan at the end of 18 months. The yellow arrow indicates the larger flap from the free bipaddled ALT flap, the green arrow indicates the smaller flap from the free bipaddled ALT flap and the red arrow indicates the narrow laryngeal cavity. ALT = anterolateral thigh.
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An MRI and CT scan at the end of 18 months postosurgery shows that laryngostenosis but no locoregional tumor recurrence are observed (see Fig. 5).
Postoperative video-laryngoscopy at the end of 18 months.
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F6
At the same time, the video-laryngoscpy at the end of 18 months postosurgery also shows laryngostenosis (see Fig. 6).