1
|
Chang C, Rodríguez-Mantilla IE, Nanni J, Farid Y, Chen HC. Five key reasons autologous bowel flap excels over skin flap in voice reconstruction. J Plast Reconstr Aesthet Surg 2024; 95:15-16. [PMID: 38865838 DOI: 10.1016/j.bjps.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Chad Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Iván Enrique Rodríguez-Mantilla
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Plastic and Reconstructive Surgery, Hospital de San José. Fundación Universitaria de Ciencias de la Salud, Bogotá D.C, Colombia
| | - Jacopo Nanni
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Plastic. Reconstructive and Aesthetic Surgery, Policlinico "Umberto I" Rome, Sapienza University of Rome, Rome, Italy
| | - Yasser Farid
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Plastic and Reconstructive Surgery, Université Libre de Bruxelles, Brussels, Belgium
| | - Hung-Chi Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; International Center, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
2
|
Lin KKY, Chen HC, Chen SH. Comparison of ileocolon flap and jejunum flap for voice reconstruction. Microsurgery 2023; 43:420-421. [PMID: 37060234 DOI: 10.1002/micr.31049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/02/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Affiliation(s)
| | - Hung-Chi Chen
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College Taoyuan, Taiwan
| |
Collapse
|
3
|
Salzillo R, Boriani F, Carta F, Tatti M, Atzeni M, Persichetti P, Haywood RM, Puxeddu R, Figus A. Perforator‐based chimeric anterolateral thigh flap U‐shaped insetting for total pharyngoesophageal reconstruction: Surgical technique and functional outcomes. Microsurgery 2022; 43:347-356. [PMID: 36468794 DOI: 10.1002/micr.30991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pharyngoesophageal reconstruction with the tubed anterolateral thigh (ALT) flap is burdened by possible strictures and pharyngocutaneous fistulae (PCF). We present our experience with the U-shaped insetting of perforator-based chimeric ALT flap focusing on surgical technique, complications and functional outcomes. METHODS We retrospectively included 10 patients with a total circumferential defect of the hypopharynx undergoing reconstruction with ALT flap. A perforator-based chimeric ALT flap with two independent skin paddles was harvested: the trapezoid paddle with the greater base cranially and the height oriented vertically was used for pharyngoesophageal reconstruction while the second paddle was exteriorized and used for flap monitoring and reducing tension on skin closure. Mean age was 56.4 years. Eight patients were affected by squamous cell carcinoma. Modified barium swallow radiogram and fiberoptic laryngoscopy were performed to assess strictures and PCFs. Swallowing and speech outcomes were evaluated through the Deglutition Handicap Index (DHI), M.D. Anderson Dysphagia Inventory (MDADI) and Voice Handicap Index (VHI) questionnaires. RESULTS Mean flap dimension was 7.9 × 6 × 9.2 cm. Mean ischemia time was 58.2 min (range 42-80). No flap loss nor flap-related complications were reported. Two PCFs were observed. Fiberoptic laryngoscopy documented a complete integration of the flap with no strictures or stenosis. Mean follow-up was 13.6 months (range 1-45 months). Mean DHI score was 33.8, mean MDADI score was 62.5, mean VHI score was 32.2. CONCLUSIONS The ALT flap U-shaped insetting is a reliable option for pharyngoesophageal reconstruction yielding a high success rate, low number of strictures and fistulae and good swallowing and voice outcomes.
Collapse
Affiliation(s)
- Rosa Salzillo
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
- Campus Bio‐Medico University of Rome, Department of Plastic, Reconstructive and Aesthetic Surgery University Hospital Campus Bio‐Medico Rome Italy
| | - Filippo Boriani
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
| | - Filippo Carta
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Otorhinolaryngology Unit University Hospital Duilio Casula Cagliari Italy
| | - Melania Tatti
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Otorhinolaryngology Unit University Hospital Duilio Casula Cagliari Italy
| | - Matteo Atzeni
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
| | - Paolo Persichetti
- Campus Bio‐Medico University of Rome, Department of Plastic, Reconstructive and Aesthetic Surgery University Hospital Campus Bio‐Medico Rome Italy
| | - Richard M. Haywood
- Norfolk and Norwich University Hospital NHS Foundation Trust, Department of Plastic and Reconstructive Surgery University of East Anglia, Norwich Medical School Norwich UK
| | - Roberto Puxeddu
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Otorhinolaryngology Unit University Hospital Duilio Casula Cagliari Italy
| | - Andrea Figus
- University of Cagliari, Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit University Hospital Duilio Casula Cagliari Italy
| |
Collapse
|
4
|
Escandón JM, Santamaría E, Prieto PA, Duarte-Bateman D, Ciudad P, Pencek M, Langstein HN, Chen HC, Manrique OJ. Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes. Arch Plast Surg 2022; 49:378-396. [PMID: 35832153 PMCID: PMC9142245 DOI: 10.1055/s-0042-1748652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.
Collapse
Affiliation(s)
- Joseph M. Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Eric Santamaría
- Department of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Cancer Institute, Mexico City, Mexico
| | - Peter A. Prieto
- Surgery Department, University of Rochester Medical Center, New York; Wilmot Cancer Institute, University of Rochester Medical Center, New York
| | | | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Megan Pencek
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Howard N. Langstein
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Hung-Chi Chen
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Oscar J. Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
5
|
Lin YS, Mousavi SA, Chen HC. Free Colon Tissue Transfer for the Management of Xerostomia in Head and Neck Cancer Patients: A Bacteriological Study and Clinical Case Series. J Plast Reconstr Aesthet Surg 2022; 75:2676-2683. [PMID: 35599216 DOI: 10.1016/j.bjps.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 03/02/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patients with head and neck cancer may suffer from xerostomia after repetitive surgery or radiation therapy. Free colon tissue transfer was used to restore the lubrication of the oral cavity, and a bacteriological study in mice was conducted to evaluate how the intestine transfer from the intra-abdominal to extra-abdominal locations may affect bacterial colonization. PATIENTS AND METHODS Twelve patients received free colon transfer for the reconstruction of their intraoral mucosal defect following trismus release. Thirty-five patients received ileocolon flap transfer to fill the pharyngeal defects. In an animal study with mice, a pedicled ileum segment was transferred to the subcutaneous space of the abdominal wall. The transferred ileum segments were biopsied for bacterial genome analysis after 3 months. RESULTS All but one transferred flap survived. Colon secretion was suitable for oral lubrication without the unpleasant smell 1 month postoperatively. In an animal study, genome analysis showed that the same bacterial species still existed in the transferred intestinal tissue. CONCLUSIONS No unpleasant smell or infections were noted in this clinical series despite the animal study showing that the bacterial spectrum did not change in the transferred intestine. Therefore, free colon tissue transfer could safely provide lubrication in patients with xerostomia.
Collapse
Affiliation(s)
- Ying-Sheng Lin
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taiwan; Division of Plastic and Reconstructive Surgery, National Taiwan University Hospital Yunlin Branch, Taiwan
| | | | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taiwan.
| |
Collapse
|
6
|
Aksoyler D, Losco L, Sert G, Chen SH, Chen HC. Risks of Laparoscopic Harvest of Free Intestinal Flaps for Esophageal Reconstruction. Surg Laparosc Endosc Percutan Tech 2021; 31:742-749. [PMID: 34320594 DOI: 10.1097/sle.0000000000000981] [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: 12/30/2020] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Performing ablative surgery using an laparoscope is a common practice. However, its use in the harvest of a segment of intestine for reconstruction has 2 major challenges: risk of damage to the vascular pedicle of the flap as well as to the vessels of other parts of the intestine that remain in the peritoneal cavity and risk of damage to the intestinal flap while pulling it out through a small opening in the abdominal wall. The aim of this study was to report advantages and disadvantages of harvesting free intestinal flaps using the laparoscopic method, explaining the challenges faced and lessons learned from this experience. PATIENTS AND METHODS Free intestinal flaps were harvested by laparoscopy in 12 patients aged 28 to 63 years. There were 9 free jejunal flaps for the reconstruction of the cervical esophagus and 3 ileocolic flaps for the reconstruction of both the cervical esophagus and voice reconstruction. RESULTS In 1 patient, laparoscopy was converted to laparotomy due to previous colectomy, which resulted in compromised circulation to the rest of the colon. One jejunal flap had leakage at its pharyngeal end; therefore, a pectoralis major myocutaneous flap was used for closure. In addition, 1 ileocolic flap had partial loss of its anterior wall, and a free anterolateral flap was used as a patch for closure. Furthermore, it was very difficult to harvest 1 free jejunal flap due to the thick and fat mesentery. CONCLUSION Prolonged operative times, unexpected leakage at the anastomosis sites, partial loss of flaps, possible risk of vascular pedicle damage or venous compromise, demanding pedicle dissection in obese patients, and requirement of conversion to laparotomy are the major drawbacks of harvesting free intestinal flaps by laparoscopy.
Collapse
Affiliation(s)
- Dicle Aksoyler
- Department of Plastic Surgery, Nicklaus Children's Hospital, Miami, FL
| | - Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gokhan Sert
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung
| | - Shih-Heng Chen
- Department of Plastic Reconstructive and Aesthetic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Chi Chen
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung
| |
Collapse
|
7
|
Lu YA, Pei YC, Chuang HF, Lin LY, Hsin LJ, Kang CJ, Huang SF, Chiang HC, Tsao CK, Fang TJ. Speech Performance after Anterolateral Thigh Phonatory Tube Reconstruction for Total Laryngectomy. Laryngoscope 2020; 131:1349-1357. [PMID: 33280117 DOI: 10.1002/lary.29005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Traditionally, after total laryngopharyngectomy (TLP), patients cannot speak without a prosthesis or an artificial larynx. In Taiwan, most patients use a commercialized pneumatic laryngeal device (PLD). Phonatory tube reconstruction with the anterolateral thigh (ALT) flap is a novel, modified version of synchronous digestive and phonatory reconstruction involving a free muscular cutaneous flap. This study reviewed and compared speech performance between patients who underwent novel flap reconstruction and conventional PLD users. METHOD We retrospectively reviewed patients with laryngeal or hypopharyngeal cancer who underwent TLP from August 2017 to September 2019. The voice handicap index (VHI), speech intelligibility, acoustic and aerodynamic analysis results, and speech range profile (SRP) were compared between patients who underwent ALT phonatory tube reconstruction (ALT group) and those using PLDs (PLD group). RESULTS Twenty patients were included; 13 patients were included in the ALT group, and 7 patients were included in the PLD group. Compared to the PLD group, the ALT group had a better fundamental frequency range (P < .001) and semitone range (P < .001) during speech but showed worse jitter, shimmer, and harmonic-to-noise ratios. The two groups showed comparable VHI and speech intelligibility performance. CONCLUSIONS The ALT phonatory tube, a novel flap for reconstruction, can restore digestive and voice functions simultaneously. Compared with PLD use, ALT phonatory tube reconstruction yields an improved speech range and comparable levels of voice handicap and speech intelligibility, suggesting that the technique is a good alternative for patients after TLP. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1349-1357, 2021.
Collapse
Affiliation(s)
- Yi-An Lu
- Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Yun Lin
- Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Jen Hsin
- Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Chen Chiang
- Graduate School of Management, Ming Chuan University, Taipei, Taiwan
| | - Chung-Kan Tsao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
8
|
Sokoya M, Bahrami A, Vincent A, Inman J, Mourad M, Sawhney R, Ducic Y. Pharyngeal Reconstruction with Microvascular Free Tissue Transfer. Semin Plast Surg 2019; 33:78-80. [PMID: 30863217 DOI: 10.1055/s-0039-1677877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reconstruction of pharyngoesophageal defects after total laryngectomies and extirpation of hypopharyngeal and upper esophageal carcinomas presents a challenging task. Goals of reconstruction include adequate voice rehabilitation and restoration of normal swallowing. The reconstructive armamentarium contains many options for reconstruction and creation of a new upper digestive tract. This review article focuses on the most commonly used free tissue transfer options for the reconstruction of these defects, with an assessment of their advantages and disadvantages.
Collapse
Affiliation(s)
| | - Arash Bahrami
- Department of Otolaryngology Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Aurora Vincent
- Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Jared Inman
- Department of Otolaryngology Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Moustafa Mourad
- Division of Otolaryngology-Head and Neck Surgery, Metropolitan Hospital, New York, New York
| | - Raja Sawhney
- Department of Otolaryngology-Head/Neck Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| |
Collapse
|