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Matsumoto D, Otani N, Seike S, Kubo T. Reconstruction with free jejunal flap in dystrophic epidermolysis bullosa complicated with hypopharyngeal cancer: A case report. Microsurgery 2024; 44:e31207. [PMID: 38895936 DOI: 10.1002/micr.31207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/04/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
Epidermolysis bullosa (EB) encompasses a range of rare genetic dermatological conditions characterized by mucocutaneous fragility and a predisposition to blister formation, often triggered by minimal trauma. Blisters in the pharynx and esophagus are well-documented, particularly in dystrophic EB (DEB). However, there have been few reports of mucocutaneous squamous cell carcinoma (SCC) in the head and neck region, for which surgery is usually avoided. This report presents the first case of free jejunal flap reconstruction after total pharyngolaryngoesophagectomy for hypopharyngeal cancer in a 57-year-old patient with DEB. The patient with a known diagnosis of DEB had a history of SCC of the left hand and esophageal dilatation for esophageal stricture. PET-CT imaging during examination of systemic metastases associated with the left-hand SCC revealed abnormal accumulation in the hypopharynx, which was confirmed as SCC by biopsy. Total pharyngolaryngoesophagectomy was performed, followed by reconstruction of the defect using a free jejunal flap. A segment of the jejunum, approximately 15 cm in length, was transplanted with multiple vascular pedicles. The patient made an uneventful recovery postoperatively and was able to continue oral intake 15 months later with no complications and no recurrence of SCC in the head and neck region. While cutaneous SCC is common in DEB, extracutaneous SCC is relatively rare. In most previous cases, non-surgical approaches with radiotherapy and chemotherapy were chosen due to skin fragility and multimorbidity. In the present case, vascular fragility and mucosal damage of the intestinal tract were not observed, and routine vascular and enteric anastomoses could be performed, with an uneventful postoperative course. Our findings suggest that highly invasive surgery, including free tissue transplantation such as with a free jejunal flap, can be performed in patients with DEB.
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Affiliation(s)
- Daiki Matsumoto
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoya Otani
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tateki Kubo
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Hirano T, Moriyama M, Abe N, Tateyama K, Shibata T, Takeno S, Inomata M, Suzuki M. Reconstruction using a free jejunal patch flap in salvage head and neck surgery after radiotherapy. Acta Otolaryngol 2023; 143:996-1000. [PMID: 38189417 DOI: 10.1080/00016489.2023.2298472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Chemoradiotherapy is a standard treatment for functional preservation in patients with advanced head and neck carcinoma. However, chemoradiotherapy increases the risk of postoperative complications. AIMS/OBJECTIVES We report the usefulness of reconstruction using a free jejunal patch flap in treating recurrence or residual head and neck carcinoma after radiotherapy. Furthermore, we investigated the factors for the occurrence of postoperative complications in patients who underwent salvage surgery using a free flap transfer. MATERIAL AND METHODS This study included 41 patients with head and neck carcinoma who underwent salvage surgery using a free flap transfer, including 11 patients who underwent reconstruction using a free jejunal patch flap. Prognostic analysis was performed for the development of complications. RESULTS Ten jejunal patch flaps survived without microvascular problems. One patient underwent revision reconstructive surgery because of flap failure. However, no patient had a pharyngocutaneous fistula. Oral intake could be resumed in all patients at a median 14 days postoperatively. Multivariate logistic regression analysis indicated that the use of cutaneous flaps was significantly associated with the development of complications. CONCLUSIONS AND SIGNIFICANCE Free jejunal patch flaps can be considered useful for head and neck reconstruction after radiotherapy for early intake resumption and complication prevention.
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Affiliation(s)
- Takashi Hirano
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Munehito Moriyama
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuyuki Abe
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kaori Tateyama
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tomotaka Shibata
- Department of Gastroenterological Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Shinsuke Takeno
- Department of Surgery, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Masafumi Inomata
- Department of Gastroenterological Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Masashi Suzuki
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
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Tokashiki K, Okamoto I, Okada T, Sato H, Yamashita T, Matsuki T, Kondo T, Fushimi C, Masubuchi T, Miura K, Omura G, Tsukahara K. Postoperative Complications and Swallowing Function after Jejunal and Skin Flap Reconstruction for Hypopharyngeal Carcinoma-A Multicenter Retrospective Study. J Clin Med 2022; 11:jcm11051464. [PMID: 35268555 PMCID: PMC8910937 DOI: 10.3390/jcm11051464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/13/2022] Open
Abstract
This study compared the incidence of perioperative complications and swallowing function between free jejunal flap reconstruction and cutaneous free tissue flap construction. We included 223 patients who underwent hypopharyngeal reconstruction using free flap. At discharge, +the free jejunal flap was associated with a Functional Oral Intake Scale (FOIS) score of 1-6 in 132 cases (70%) and a score of 7 in 56 cases (30%). Regarding the cutaneous free tissue flaps, FOIS scores of 1-6 were observed in 18 cases (51%), and a score of 7 was noted in 17 cases (49%). Donor site complications occurred in 12% of the patients who underwent free jejunal flap procedures and in none of the patients who underwent cutaneous free tissue flap procedures. We found that the free jejunal flap had a regular dietary intake rate in 56 patients (30%), whereas cutaneous free tissue flaps had a regular dietary intake rate in 17 patients (49%). Cutaneous free tissue flaps had a significantly higher regular dietary intake rate at discharge and a significantly lower incidence of donor site complications than free jejunal flaps. In conclusion, free-flap reconstruction may be a better method than free jejunal flap reconstruction for the treatment of hypopharyngeal cancer.
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Affiliation(s)
- Kunihiko Tokashiki
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (K.T.); (T.O.); (H.S.); (K.T.)
| | - Isaku Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (K.T.); (T.O.); (H.S.); (K.T.)
- Correspondence: ; Tel.: +81-3-3342-6111; Fax: +81-3-3346-9275
| | - Takuro Okada
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (K.T.); (T.O.); (H.S.); (K.T.)
| | - Hiroki Sato
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (K.T.); (T.O.); (H.S.); (K.T.)
| | - Taku Yamashita
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (T.Y.); (T.M.)
| | - Takashi Matsuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (T.Y.); (T.M.)
| | - Takahito Kondo
- Department of Otolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo 193-0998, Japan;
| | - Chihiro Fushimi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan; (C.F.); (T.M.); (K.M.)
| | - Tatsuo Masubuchi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan; (C.F.); (T.M.); (K.M.)
| | - Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan; (C.F.); (T.M.); (K.M.)
| | - Go Omura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan;
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (K.T.); (T.O.); (H.S.); (K.T.)
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Raghavan P, Vakharia K, Morales RE, Mukherjee S. Surgical Free Flaps and Grafts in Head and Neck Reconstruction: Principles and Postoperative Imaging. Neuroimaging Clin N Am 2021; 32:75-91. [PMID: 34809845 DOI: 10.1016/j.nic.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review article discusses the basic principles behind the use of flaps and grafts for reconstructive surgery in the head and neck, with a special emphasis on the types of commonly used free flaps, their imaging appearance as well as some frequently encountered postoperative complications. Given the ubiquity and complexity of these reconstructive techniques, it is essential that head and neck radiologists be familiar in distinguishing between the expected evolving findings, complications, and tumor recurrence.
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Affiliation(s)
- Prashant Raghavan
- Neuroradiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology-Head and Neck Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 419 West Redwood Street, Suite 370, Baltimore, MD 21201, USA
| | - Robert E Morales
- Neuroradiology, Diagnostic Neuroradiology Fellowship, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, 1215 Lee Street, Charlottesville, VA 22908-1070, USA
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Comparison between anterolateral thigh free flap and jejunal flap for tissue reconstruction in patients underwent resection of pharyngoesophageal squamous cell carcinoma after radiotherapy failure: a retrospective study. BMC Surg 2021; 21:389. [PMID: 34727910 PMCID: PMC8561938 DOI: 10.1186/s12893-021-01349-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Anterolateral thigh (ALT) free flap and jejunal flap (JF) were commonly used in tissue reconstruction for pharyngoesophageal squamous cell carcinoma (PESCC) with worsening tissue adhesion and necrosis after radiotherapy failure. However, the results of tissue reconstruction and postoperative complications of these two flaps are controversial. The purpose of this study was to compare outcomes between group ALT free flap and group JF in PESCC after radiotherapy failure. METHODS Intraoperative information and postoperative outcomes of patients with PESCC after radiotherapy failure who underwent ALT and JF reconstruction from January 2005 to December 2019 were compared and analyzed. RESULTS The defect size of ALT (Numbers, 34) and JF (Numbers, 31) was 36.19 ± 11.35 cm2 and 35.58 ± 14.32 cm2 (p = 0.884), respectively. ALT and JF showed no significant difference in operation time (p = 0.683) and blood loss (p = 0.198). For postoperative outcomes within 30 days both in recipient site and donor site including wound bleeding, wound dehiscence, wound infection, and pharyngocutaneous fistula, ALT free flap and JF showed similar results. Flap compromise (Numbers, 2 VS.3, p = 0.663), flap take backs (Numbers, 1 VS.1, p = 1.000), partial flap failures (Numbers, 4 VS.2, p = 0.674), and total flap failures (Numbers, 0 VS.0, p = 1.000) showed no difference between the two groups. In addition, no significance was found in hypoproteinemia between the two groups (Numbers, 4 VS.2, p = 0.674). ALT free flap was not statistically different from JF in the incidence of dysphagia at the postoperative 6 months (Numbers of liquid diet, 5VS.5; Numbers of partial tube feeding, 6VS.7; Numbers of total tube feeding, 3VS.1, p = 0.790) and 12 months (Numbers of liquid diet, 8VS.7; Numbers of partial tube feeding, 8VS.7; Numbers of total tube feeding, 5VS.5, p = 0.998). The cause of dysphagia not found to differ between the two groups both in postoperative 6 months (p = 0.814) and 12 months (p = 0.845). CONCLUSION Compared with JF, ALT free flap for PESCC patients after radiotherapy failure showed similar results in postoperative outcomes. ALT free flap may serve as a safe and feasible alternative for PESCC patients after radiotherapy failure.
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Abstract
PURPOSE OF REVIEW The head and neck reconstructive surgeon is intimately familiar with the anterolateral thigh, radial forearm, and parascapular flaps. This review serves to describe the major abdominal-based free tissue transfers in head and neck reconstruction that can be used as alternatives to these traditional workhorse flaps. RECENT FINDINGS Abdominal-based free flaps, while not traditionally used in head and neck reconstruction, are great alternatives or second-line flaps. For example, the deep circumflex iliac artery flap is an excellent alternative to the fibular free flap due to its bone height and greater overall quality of life. SUMMARY This review article serves to review the major abdominal-based free tissue transfers in head and neck reconstruction in order to expand the toolbox of the head and neck surgeon.
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Relationship between the Incidence of Postoperative Fistula or Dysphagia and Resection Style, Gastric Tube Formation, and Irradiation following Free Jejunal Flap Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2663. [PMID: 32309103 PMCID: PMC7159956 DOI: 10.1097/gox.0000000000002663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
Background: The purpose of this study was to examine the relationship between the incidence of dysphagia or fistula formation in an anastomotic region and factors such as extent of resection, gastric tube formation, and irradiation among patients who underwent free jejunal flap transfer. Methods: We retrospectively examined 100 cases (88 men and 12 women; average age, 65.8 years; range, 46–88 years) in whom the evaluation of postoperative oral intake was possible after undergoing total pharyngo-laryngo-esophagectomy (TPLE) and free jejunal flap transfer. Chi-square test (with Fisher transformation, if necessary) was performed to analyze the relationship among resection styles (the resection margin extended to the oropharynx or to the cervical esophagus and gastric tube elevation), radiation therapy history, and incidence of dysphagia or fistula formation. Results: One hundred patients were analyzed, and complications such as postoperative fistula and dysphagia occurred in 8 (8.0%) and 20 patients (20.0%), respectively. However, no significant correlation was found between various resection factors and fistula formation or adverse events. At the reconstruction site, other complications such as postoperative lymphorrhea (7%), postoperative hematoma (4%), trachea necrosis (4%), cervical flap necrosis (1%), and thyroid necrosis (1%) occurred. These complications were managed by a cervical open wound and additional minor operation as needed. Conclusion: Thus, free jejunal transfer for TPLE is a good reconstruction technique with few complications and postoperative adverse events, regardless of the extent of resection and preoperative radiation therapy.
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Onoda S, Kinoshita M. Salvage Surgery for Jejunal Necrosis After a Free Jejunal Transfer. Ann Surg Oncol 2019; 26:2122-2126. [DOI: 10.1245/s10434-019-07348-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/18/2022]
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