Reinforcement of skin flap tracheal reconstruction with porous titanium nickelide implants: A novel approach to persistent tracheal defect closure.

OBJECTIVE: The study objective was to evaluate the safety and efficacy of porous titanium nickelide mesh implants for reinforcing skin flap reconstruction of persistent tracheal defects after prolonged tracheostomy and laryngotracheal reconstruction. METHODS: This retrospective case series included 60 patients with persistent tracheal defects treated between June 2013 and December 2020. An experimental group (n = 17) received external porous titanium nickelide implant reinforcement, and a control group (n = 43) underwent conventional skin flap closure without reinforcement. The experimental group was characterized by significantly more severe tracheomalacia (P < .001), reflecting the nonrandomized, clinician-directed selection protocol. Primary outcomes included flap stability, airway patency, and complication rates. Secondary outcomes included granulation tissue formation and need for revision surgery. RESULTS: All 17 experimental group patients achieved stable tracheal reconstruction without implant-related complications (erosion, infection, or displacement) during a median follow-up of 48 months (range, 12-120 months). Flap instability on dynamic bronchoscopy was absent in the experimental group versus 18.6% in controls (P = .046). Granulation tissue formation occurred more frequently in the experimental group (58.8% vs 27.9%; P = .047). However, all cases were limited in size, did not compromise airway patency, and were successfully managed with a single session of argon plasma coagulation. No restenosis occurred in either group. CONCLUSIONS: Porous titanium nickelide reinforcement provides durable biomechanical support for skin flap tracheal reconstruction, preventing flap instability and maintaining airway patency in a higher-risk cohort selected for severe tracheomalacia. This technique is a safe and effective option when primary tracheal resection is not feasible. The selection bias inherent to this nonrandomized series should be considered when interpreting superiority claims.