Newswise — CLEVELAND – While Kathleen Brasko, 62, was recovering from complications from blocked arteries in her lungs and bleeding in the brain, her windpipe collapsed, causing severe breathing problems.
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.”
To learn more about the Voice and Swallowing Center, see http://ow.ly/B58oD. A video about Ms. Brasko’s story is at https://www.youtube.com/watch?v=AA5Kkaot9Ko.
About University HospitalsUniversity Hospitals, the second largest employer in Northeast Ohio with 25,000 employees, serves the needs of patients through an integrated network of 14 hospitals, 28 outpatient health centers and primary care physician offices in 15 counties. At the core of our $3.5 billion health system is University Hospitals Case Medical Center, ranked among America’s 50 best hospitals by U.S. News & World Report in all 12 methodology-ranked specialties. The primary affiliate of Case Western Reserve University School of Medicine, UH Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation, including cancer, pediatrics, women's health, orthopaedics, radiology, neuroscience, cardiology and cardiovascular surgery, digestive health, transplantation and genetics. Its main campus includes UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center at Case Western Reserve University. For more information, go to www.uhhospitals.org.
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