Doctors reconstruct woman's windpipe with ear cartilage

To help her breathe, physicians performed a tracheotomy, a surgically created hole through the front of her neck and into her windpipe (trachea). A "trach tube" provided an air passage for her.

Ms. Brasko, from Willard, Ohio, went to see Nicole Maronian, MD, Director of the Voice and Swallowing Center at University Hospitals Case Medical Center, to see if more could be done.

"She didn't want to go through life with a tube in her windpipe," said Dr. Maronian, who is also Associate Professor of Otolaryngology at the Case Western Reserve University School of Medicine "She wanted to be normal again. So we moved forward to consider reconstructive options."

Dr. Maronian said the usual procedures described in the text books did not apply to Ms. Brasko's case. "We started by using traditional techniques and were able to gain some ground toward restoring airflow through the windpipe. However, the breakdown of her windpipe was so severe that we needed healthy tissue to rebuild the front wall of her windpipe -- tissue that had to come from another part of the body."

She approached her colleague Chad Zender, MD, head and neck surgeon at UH, who had a colleague who used ear grafts to reconstruct smaller defects in patients.

"We decided to use a similar concept where we would implant some cartilage from the ear and stack the pieces together to get three to five cm length of composite graft to reconstruct the windpipe," said Dr. Zender who is also Assistant Professor of Otolaryngology at CWRU School of Medicine.

He took some cartilage from each ear and transplanted the tissue into her forearm, where the cartilage healed under the skin and on top of deeper tissue (a deeper layer called fasciae) and established its own blood flow. After six weeks, the cartilage was ready for transplant.

"Then I harvested that skin, sort of a rectangular piece, with the cartilage underneath," said Dr. Zender. "I also took the fasciae that's sandwiched on the deep side of that tissue. I took the radial artery, and the veins that accompany it, and just like a kidney transplant, I brought that tissue up, revascularized it by coupling it with arteries and veins in the neck, and sutured it into the windpipe."

Dr. Maronian said there are similarities between ears and the windpipe. In terms of the type of tissue, both have cartilage which forms a rigid skeleton. And the ear, especially the bowl part of the ear, has a very nice shape that matches the contour needed in the front portion of the windpipe wall.

Since her procedure in May, Ms. Brasko has recovered well. "Sleeping, walking talking, breathing, it's all good!" she said. Her husband, Mike Brasko, said, "It's amazing, truly amazing."