Composite vascularized free-rib and pleural transfer for laryngotracheal reconstruction

A free rib pleura composite vascularized transfer for repair of a defect in the canine upper airway is discussed and the results are reported. The procedure was carried out on eight dogs. One dog died from the anesthetic. Three surgical failures resulted from technical difficulties: failure of the vascular anastomosis, torsion of the vascular pedicle, and hemorrhage. Four dogs successfully maintained their airways, although one demonstrated bone absorption. Bone scanning, angiography, tetracycline labeling, and light microscopy confirmed active osseous metabolism of the rib, providing further evidence of the adequacy of periosteal circulation in maintaining normal rib metabolism. Scanning electron microscopy and conventional light microscopy demonstrated the development of a healthy respiratory epithelium. Thus a free flap of rib and attached pleura will provide adequate skeletal support and a moist, functioning, epithelial lining in a single-stage operation for reconstruction of a laryngotracheal defect in the normal dog.