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Merritt RE. Conduit Selection for Reconstruction After Esophagectomy for Esophageal Cancer. Surg Oncol Clin N Am 2024; 33:549-556. [PMID: 38789197 DOI: 10.1016/j.soc.2024.01.001] [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: 05/26/2024]
Abstract
The reconstruction of the esophagus after esophagectomy presents many technical and management challenges to surgeons. An effective gastrointestinal conduit that replaces the resected esophagus must have adequate length to reach the upper thoracic space or the neck, have robust vascular perfusion, and provide sufficient function for an adequate swallowing mechanism. The stomach is currently the preferred conduit for esophageal reconstruction after esophagectomy. However, there are circumstances, where the stomach cannot be utilized as a conduit. In these cases, an alternative conduit must be considered. The current alternative conduits include colon, jejunum, and tubed skin flaps.
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Affiliation(s)
- Robert E Merritt
- Division of Thoracic Surgery, The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, N847 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
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Kim SD, Kim IG, Tran HN, Cho H, Janarthanan G, Noh I, Chung EJ. Three-Dimensional Printed Design of Antibiotic-Releasing Esophageal Patches for Antimicrobial Activity Prevention. Tissue Eng Part A 2021; 27:1490-1502. [PMID: 33847168 DOI: 10.1089/ten.tea.2020.0268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pharyngoesophageal defects can cause exposure to various bacterial flora and severe inflammation. We fabricated a biodegradable polycaprolactone (PCL) patch composed of both thin film and three-dimensional (3D) printed lattice, and then investigated the efficacy of pharyngoesophageal reconstruction by using 3D printed antibiotic-releasing PCL patches that inhibited early inflammation by sustained tetracycline (TCN) release from both thin PCL films and printed rods implanted in esophageal partial defects. PCL was 3D printed in lattice form on a presolution casted PCL thin film at ∼100 μm resolution. TCN was loaded onto the PCL-printed patches by 3D printing a mixture of TCN and PCL particles melted at 100°C. TCN exhibited sustained release in vitro for over 1 month. After loading TCN, the patches showed decreased tensile strength and Young's modulus, and less than 20% TCN was slowly released from the 2.5% TCN-loaded PCL patches over 150 days. Cytotoxicity tests of extract solutions from patch samples demonstrated excellent in vitro cell compatibility. Antibiotic-releasing PCL patches were then transplanted into partial esophageal defects in rats. Microcomputed tomography analysis revealed no leak of orally injected contrast agent in the entire esophagus. Tissue remodeling was examined through histological responses of M1 and M2 macrophages. In particular, the 1% and 3% TCN patch groups exhibited significant muscle layer regeneration by desmin immunostaining. Further histological and immunofluorescence analyses revealed that the 1% and 3% TCN patch groups exhibited the best esophageal regeneration according to reepithelialization, neovascularization, and elastin texture around the implanted sites. Our antibiotic-releasing patch successfully consolidates the regenerative potential of esophageal muscle and mucosa and the antibacterial activity of TCN for 3D esophageal reconstruction. Impact statement Anastomosis site leakage and necrosis after pharyngoesophageal transplantation inevitably causes mortality because the mediastinum and neck compartments become contaminated. Herein, we present antibiotic-releasing pharyngoesophageal patch that prevents saliva leakage and has an antimicrobial effect. We have demonstrated antibiotic release profile and mechanical properties for esophageal transplantation. Upon esophageal transplantation of antibiotic-releasing polycaprolactone patches, antimicrobial effects and muscle regeneration around the graft sites were clearly identified in the group containing 1% and 3% of tetracycline. The esophageal graft led to the remarkable recovery throughout reepithelialization, neovascularization, and elastin texture of around the implanted sites. We believe that current system is capable of various applications that require antibacterial in vivo.
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Affiliation(s)
- Seong Dong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, National Medical Center, Seoul, Republic of Korea
| | - In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hao Nguyen Tran
- Department of Chemical and Biomolecular Engineering, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Hana Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gopinathan Janarthanan
- Department of Chemical and Biomolecular Engineering, Seoul National University of Science and Technology, Seoul, Republic of Korea
- Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Insup Noh
- Department of Chemical and Biomolecular Engineering, Seoul National University of Science and Technology, Seoul, Republic of Korea
- Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
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A systematic review and meta-analysis of urethral complications and outcomes in transgender men. J Plast Reconstr Aesthet Surg 2021; 75:10-24. [PMID: 34607781 DOI: 10.1016/j.bjps.2021.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 04/19/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Urologic problems, such as urethral fistulas and strictures, are among the most frequent complications occurring after phalloplasty. Although many studies have reported successful phalloplasty and urethral reconstruction with reliable outcomes in transgender men, no method has become standardized so far. This study aimed to summarize the results of reports on urological complications and outcomes in transgender men with respect to various types of urethral reconstruction. METHODS A comprehensive literature search of PubMed, Scopus, and Google Scholar databases was conducted for studies related to phalloplasty in transsexuals. Data on various phallic urethral techniques, urethral complications, and outcomes were collected and analyzed using the random-effects model. RESULTS A total of 21 studies (1,566 patients) were included: eight studies (1,061 patients) on "tube-in-tube," nine studies (273 patients) on "prelaminated flap," and six studies (221 patients) on "second flap." Compared with the tube-in-tube technique, the prelaminated flap was associated with a significantly higher urethral stricture/stenosis rate; however, there was no difference between the prelaminated flap and the second flap techniques. For all phalloplasty patients, the pool rate of urethral fistula or stenosis is 48.9%, the rate of the ability to void while standing is 91.5%, occurrence rate of tactile or erogenous sensation is 88%, the prosthesis complication rate is 27.9%, and patient-reported satisfactory outcome rate is 90.5%. CONCLUSION Urethral reconstruction with a prelaminated flap was associated with a significantly higher urethral stricture rate and increased need of revision surgery compared with that observed using a skin flap. Overall, most patients were able to void while standing and were satisfied with the outcomes.
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Bae S, DiBalsi MJ, Meilinger N, Zhang C, Beal E, Korneva G, Brown RO, Kornev KG, Lee JS. Heparin-Eluting Electrospun Nanofiber Yarns for Antithrombotic Vascular Sutures. ACS APPLIED MATERIALS & INTERFACES 2018; 10:8426-8435. [PMID: 29461035 DOI: 10.1021/acsami.7b14888] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The surgical connection of blood vessels, anastomosis, is a critical procedure in many reparative, transplantation, and reconstructive surgical procedures. However, effective restoration of circulation is complicated by pathological clotting (thrombosis) or progressive occlusion due to excess cell proliferation that often leads to additional surgeries and increases morbidity and mortality risk for patients. Pharmaceutical agents have been tested to prevent these complications, but many have unacceptable systemic side effects. Therefore, an alternative approach to deliver these drugs at the site of injury in a controlled manner is necessary. The objective of this study was to develop electrospun nanofibers composed of polyester poly(lactide- co-glycolide) (PLGA), poly(ethylene oxide) (PEO), and positively charged copolymer, poly(lactide- co-glycolide)- graft-polyethylenimine (PgP) for electrostatic binding and release of heparin for application as an antithrombotic microvascular suture. PgP was synthesized with different coupling ratios between PLGA and branched polyethylenimine (bPEI) to obtain PgP1 (∼1 PLGA grafted to 1 bPEI) and PgP3.7 (∼3.7 PLGA grafted to 1 bPEI). Nanofiber yarns (PLGA/PEO/PgP1 and PLGA/PEO/PgP3.7) were fabricated by electrospinning. Heparin immobilization on the positively charged nanofiber yarns was visualized using fluorescein-conjugated heparin (F-Hep), and the amount of immobilized F-Hep was higher on both PLGA/PEO/PgP3.7 and PLGA/PEO/PgP1 than yarns without PgP (PLGA/PEO). We also found that F-Hep was released from both PgP-containing yarns in a sustained manner over 20 days, while over 60% of F-Hep was released within 4 h from PLGA/PEO. Finally, we observed that heparin-eluting nanofiber yarns with both PgP1 and PgP3.7 showed significantly longer clotting times than nanofiber yarns without PgP. The clotting time of PLGA/PEO/PgP3.7 was not significantly different than that of free heparin (0.5 μg/mL). These results show that heparin-eluting electrospun nanofiber yarns may offer a basis for the development of microvascular sutures with anticoagulant activity.
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Affiliation(s)
- Sooneon Bae
- Dental and Craniofacial Trauma Research & Tissue Regeneration Directorate , United States Army Institute of Surgical Research , JBSA Fort Sam Houston , Texas 78234 , United States
| | | | | | | | | | | | - Robert O Brown
- Department of Head & Neck Surgery , Greenville Health System , Greenville , South Carolina 29615 , United States
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Liu J, Zhang X, Zhen Q, Su Y, Han Z, Chen G. Esophageal reconstruction: Combined application of muscle tissue flap and inner chitosan tube stent in rabbits. Technol Health Care 2017; 24 Suppl 2:S505-12. [PMID: 27163311 DOI: 10.3233/thc-161175] [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: 11/15/2022]
Abstract
BACKGROUND Esophageal reconstruction is the key issue in esophageal surgery. However, currently there is no satisfied technique to repair esophagus after surgery. OBJECTIVE To combine an inner chitosan stent and a muscle tissue with vascular pedicle to repair the esophageal defect in cervical segment. METHODS Esophageal defect was repaired using the combination of a muscle tissue flap and a chitosan tube stent in experimental group while only muscle tissue flap was utilized in controls for comparison. One animal in each group was sacrificed at week 3, 6 and 9 after operation respectively to exam the healing status. Barium X-ray was used to evaluate the esophageal status in 12 weeks. RESULTS Histology showed the inflammatory response in 3 weeks after surgery, the chitosan stent was partially absorbed in 6 weeks, and there was no obvious fibrotic proliferation in experimental group; while the fibrotic proliferation and esophageal stenosis were obvious in controls, the chitosan stent was completely absorbed in 9 weeks, and squamous epidermis cells were observed. Twelve weeks later, the barium swallow went smoothly through the esophagus with noticeable peristalsis in the experimental group; esophageal stenosis without peristalsis was observed in controls. CONCLUSION The combination of chitosan stent and muscle tissue flap is feasible to reconstruct a partial defect in esophagus.
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Sacak B, Orfaniotis G, Nicoli F, Liu EW, Ciudad P, Chen SH, Chen HC. Back-up procedures following complicated gastric pull-up procedure for esophageal reconstruction: Salvage with intestinal flaps. Microsurgery 2015; 36:567-572. [PMID: 26679742 DOI: 10.1002/micr.22520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/30/2015] [Accepted: 09/29/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastric pull-up (GPU) is the most common procedure for restoring the continuity of the alimentary tract. Yet, complications because of anastomotic problems are reported to be as high as 25% after this procedure. Managing the neck with anastomotic leakage or stricture following failed GPU and/or radiotherapy is formidable. We report our method, basic algorithm and results with the complicated GPU procedure management with intestinal transfers . PATIENTS AND METHODS Nineteen cases referred to our department with complicated esophageal reconstruction following GPU procedure were included in this report. Of the19 patients, 18 had undergone GPU procedure for reconstruction after cancer resection (mean age 55 years) and one for idiopathic esophagitis (mean age 45years). Fifteen patients presented with severe stricture formation and 4 patients with leakage from the anastomotic site. Average time between the GPU and salvage procedures was 7.3 months for patients with stricture formation and 15.5 days for patients with leakage. Pedicled colon interposition (n = 8) was used when the upper end of the gastric tube was located below the sternoclavicular junction. A free jejunal flap (n = 11) was utilized when defects were located at the neck (above the sternoclavicular junction). RESULTS In all patients salvage procedures with intestinal flap transfer were successful with complete flap survival. Post-operative period was uneventful except of two patients with pedicled colon interposition who presented minor leakage post-operatively (10.5%). This was treated with conservative means, leading to spontaneous healing. The average follow-up for the patients with tumor resection was 11.8 months (range: 6 to 30) after the salvage procedure. All patients resumed smooth oral intake eventually. There were 16 patients who could feed with solid diet, whereas three patients were able to tolerate only soft diet. CONCLUSION Intestinal tissues can be safely and successfully transferred as salvage procedures, with meticulous technique, careful patient selection and individual flap design. While gastric pull-up remains a good procedure for esophageal reconstruction, the methods described in this report are useful as back-up armaments in complicated cases. © 2015 Wiley Periodicals, Inc. Microsurgery 36:567-572, 2016.
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Affiliation(s)
- Bulent Sacak
- Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey.,Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St Thomas' Hospital, London, UK
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - En-Wei Liu
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Heng Chen
- Department of Plastic Surgery, Chang-Gung Memorial Hospital, Taipei, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
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When the Gastrointestinal Conduit for Total Esophageal Reconstruction Is Not an Option: Review of the Role of Skin Flaps and Report of Salvage With a Single-Stage Tubed Anterolateral Thigh Flap. Ann Plast Surg 2014; 76:463-7. [PMID: 25536203 DOI: 10.1097/sap.0000000000000389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review adds to the limited body of literature describing the use of skin flaps for reconstruction of the esophagus and includes a report of a successful 1-stage, intrathoracic reconstruction of the cervical and thoracic esophagus after failed gastrointestinal conduit. Already widely used for reconstruction of the pharynx and cervical esophagus, the versatile anterolateral thigh flap can be considered an option for more extensive defects of the cervical and thoracic esophagus in this challenging patient population when gastric, jejunal, or colon conduits are not available. The authors believe the anterolateral thigh flap should be considered in 1-stage anatomic reconstruction of the cervical and thoracic esophagus in the absence of feasible gastrointestinal conduits.
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Hamilton K, Wolfswinkel EM, Weathers WM, Xue AS, Hatef DA, Izaddoost S, Hollier LH. The Delay Phenomenon: A Compilation of Knowledge across Specialties. Craniomaxillofac Trauma Reconstr 2014; 7:112-8. [PMID: 25071876 DOI: 10.1055/s-0034-1371355] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 04/22/2013] [Indexed: 12/19/2022] Open
Abstract
Objective The purpose of this article is to review and integrate the available literature in different fields to gain a better understanding of the basic physiology and optimize vascular delay as a reconstructive surgery technique. Methods A broad search of the literature was performed using the Medline database. Two queries were performed using "vascular delay," a search expected to yield perspectives from the field of plastic and reconstructive surgery, and "ischemic preconditioning," (IPC) which was expected to yield research on the same topic in other fields. Results The combined searches yielded a total of 1824 abstracts. The "vascular delay" query yielded 76 articles from 1984 to 2011. The "ischemic preconditioning" query yielded 6534 articles, ranging from 1980 to 2012. The abstracts were screened for those from other specialties in addition to reconstructive surgery, analyzed potential or current uses of vascular delay in practice, or provided developments in understanding the pathophysiology of vascular delay. 70 articles were identified that met inclusion criteria and were applicable to vascular delay or ischemic preconditioning. Conclusion An understanding of IPC's implementation and mechanisms in other fields has beneficial implications for the field of reconstructive surgery in the context of the delay phenomenon. Despite an incomplete model of IPC's pathways, the anti-oxidative, anti-apoptotic and anti-inflammatory benefits of IPC are well recognized. The activation of angiogenic genes through IPC could allow for complex flap design, even in poorly vascularized regions. IPC's promotion of angiogenesis and reduction of endothelial dysfunction remain most applicable to reconstructive surgery in reducing graft-related complications and flap failure.
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Affiliation(s)
| | | | | | - Amy S Xue
- Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniel A Hatef
- Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Bare dorsal thoracic fascial flap for esophageal defects: an experimental study with dogs. Surg Endosc 2011; 26:1682-9. [DOI: 10.1007/s00464-011-2093-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
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Integra Acellular Collagen as a Vascular Carrier for Skin Flap Prefabrication in Rats. Ann Plast Surg 2011; 67:299-302. [DOI: 10.1097/sap.0b013e3181fabc32] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Flap prefabrication and prelamination are two closely related concepts. Clinical applications of flap prefabrication and prelamination are relatively new to the field of reconstructive plastic surgery. Although the two terms are often used interchangeably in the literature, they are two distinctly different techniques. Understanding their differences is helpful in planning reconstructive strategy. They are primarily used in reconstructing complex defects where conventional techniques are not available. Flap prefabrication starts with introduction of a vascular pedicle to a desired donor tissue that on its own does not possess an axial blood supply. After a period of neovascularization of at least 8 weeks, this donor tissue can then be transferred to the recipient defect based on the newly acquired axial vasculature. Flap prelamination, in contrast, begins with building a three-dimensional structure on a reliable vascular bed. This composite structure, once matured in approximately 2 weeks, can then be transferred to the recipient defect. This article describes in detail the principles, steps, variations, and applications of these two techniques.
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Abstract
AIM: To repair the partial esophagus defect with a chitosan stent, a new esophageal prosthesis made of pulmonary tissue with vascular pedicle.
METHODS: Fifteen Japanese big ear white rabbits were divided into experimental group (n = 10) and control group (n = 5). Esophagus defect in rabbits of experimental group was repaired using lung tissue flap with a chitosan tube stent, gross and histological appearance was observed at week 2, 4 and 8 after operation, and barium sulphate X-ray screen was performed at week 10 after operation. Esophagus defect of rabbits in control group was repaired using lung tissue flap with no chitosan tube stent, gross and histological appearance was observed at week 2, 4 and 8 after operation, and barium sulphate X-ray screen was performed at week 10 after operation.
RESULTS: In the experimental group, 6 rabbits survived for over two weeks, the lung tissue flap healed esophageal defection, and squamous metaplasia occurred on the surface of lung tissue flap. At week 10 after operation, barium sulphate examination found that barium was fluent through the esophagus with no stricture or back stream, the creeping was good. In the control group, 4 rabbits survived for two weeks, the lung tissue flap healed esophageal defection with fibrous tissue hyperplasia, barium sulphate examination found that barium was fluent through the esophagus with a slight stricture or back stream, and the creeping was not good at week 10 after operation.
CONCLUSION: Esophagus defect can be repaired using lung tissue flap with an inner chitosan tube stent.
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Chen G, Shi WJ. Repairing partial esophagus defection with an inner chitosan stent in rabbits. Shijie Huaren Xiaohua Zazhi 2009; 17:236-240. [DOI: 10.11569/wcjd.v17.i3.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine feasibility of patching esophagus damage with chitosan tube stent.
METHODS: Fifty Japanese rabbits were randomly divided into two groups, experimental group (n = 25) which underwent patching center-section esophagus partial damages with body lung tissue petal (inside lining chitosan tube stent) and control group (n = 25) which underwent non-inside lining stent. At the 2nd, 4th, 8th week after surgery, healing status was observed roughly and histologically. At the 10th week after surgery, the survived rabbits were given barium meal to detect esophagus. The rabbits were followed up for survival time and death cause.
RESULTS: Forty five experimental animals survived over two weeks. Five rabbits died during perioperative period with a 10% death rate. Reliable cicatrisation between the lung tissue petal and damage area, and squamose epidermis metaplasia were observed. At the 10th week after surgery, the esophagus barium test showed that barium agents went through the esophagus smoothly, and there were no obvious stenosis or reflux and moderate peristalsis in the experiment group. However, there was mild stenosis and no obvious obstruction or reflux in the control group. Followed-up rabbits survived 6-8 months and their death cause was irrelevant to surgery.
CONCLUSION: The lung tissue petal patching esophagus damage is one feasible method, and the chitosan tube, as the inside lining stent, may prevent narrowing.
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Chen G, Shi WJ. Advance in esophagus substitute. Shijie Huaren Xiaohua Zazhi 2008; 16:3855-3858. [DOI: 10.11569/wcjd.v16.i34.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Esophageal replacement is needed to treat many esophageal diseases. Based on domestic and overseas literatures, this review analyzes and summarizes the progress in esophagus prosthesis during the last fifty years, including artificial synthetic material, biologic material, biologic composite material, biological tissue-engineering and self-pulmonary tissue flap, and explains their characters and exploratory development. The best substitute, which can be easily acquired, avirulent, with no rejection, no carcinogenicity and absorbable, has not been found yet.
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Shen KR, Austen WG, Mathisen DJ. Use of a prefabricated pectoralis major muscle flap and pedicled jejunal interposition graft for salvage esophageal reconstruction after failed gastric pull-up and colon interposition. J Thorac Cardiovasc Surg 2008; 135:1186-7. [PMID: 18455610 DOI: 10.1016/j.jtcvs.2007.08.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 07/27/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Affiliation(s)
- K Robert Shen
- Division of General Thoracic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Mass, USA.
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Roger N, Vaillant JC, Salabert AS, Rousseau G, Bitker MO, Hannoun L. [Late complications of a skin oesophagoplasty realized 45 years before: an historical case]. JOURNAL DE CHIRURGIE 2007; 144:540-543. [PMID: 18235370 DOI: 10.1016/s0021-7697(07)79784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report the case of a patient operated for the late complications of a skin-lined tube reconstruction of the esophagus performed 45 years ago. We recall the historical interest of this method for total esophageal reconstruction and emphasize the fact that it can still be a solution of last resort when intestinal tubes are no longer available.
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Affiliation(s)
- N Roger
- Service de chirurgie digestive et hépatobiliaire, Groupe Hospitalier La Pitié Salpétrière - Paris.
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Mardini S, Chen HC, Salgado CJ, Ozkan O, Cigna E, Chung TT. Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty for reconstruction of a pharyngoesophageal defect: indication and usage of the ‘funnel flap’. J Plast Reconstr Aesthet Surg 2006; 59:1241-6. [PMID: 17046635 DOI: 10.1016/j.bjps.2006.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Revised: 12/27/2005] [Accepted: 01/01/2006] [Indexed: 10/24/2022]
Abstract
The authors have designed a method of reconstruction for high pharyngeal and oesophageal defects that potentially avoids many of the disadvantages related to size mismatch at the proximal and distal end of oesophageal defects that are encountered with the use of free jejunal and colon flaps, respectively. An ileo-colon flap was used to reconstruct this type of defect where the ascending colon was anastomosed to the pharyngeal end and the ileum was anastomosed to the oesophageal end. Both sides were perfectly matched in circumference and minimal manipulation was necessary at both ends of the flap. A detailed description of the surgical technique is depicted and a case presented. While this procedure solves some of the problems encountered when dealing with this type of defect, it nevertheless does have some disadvantages and technical nuisances that are detailed and discussed in this report.
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Affiliation(s)
- Samir Mardini
- Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, Kaohsiung County 824, Taiwan, ROC
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Zhou JH, Jiang YG, Wang RW, Lin YD, Gong TQ, Zhao YP, Ma Z, Tan QY. Management of corrosive esophageal burns in 149 cases. J Thorac Cardiovasc Surg 2005; 130:449-55. [PMID: 16077412 DOI: 10.1016/j.jtcvs.2005.02.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We sought to present our experience in the management of esophageal burns. METHODS From April 1976 through October 2003, 149 patients with corrosive esophageal burns were included in this study. Treatment modalities consisted of modified intraluminal stenting in 28, colon interposition in 71, gastric transposition in 25, repair of cervical stricture with platysma myocutaneous flap in 17, and miscellaneous operations in 12 patients. Eleven of these patients underwent the above procedures twice at our institute. The remaining 7 patients were treated with conservative therapy. RESULTS Twenty-three patients recovered from intraluminal stenting, and 5 experienced stricture after stent removal. One of the 5 patients with failed stents responded to bougienage, and the remaining 4 patients required esophageal reconstruction later. Of the 71 colon interpositions, 5 patients died postoperatively, and complications consisted of proximal anastomotic fistula in 17, anastomotic stenosis in 6, and abdominal incision dehiscence in 2 patients. Postoperative complications in the 25 patients with gastric transpositions comprised anastomotic stricture in 2 patients and empyema in 1 patient. There was a cervical leak in 1 of the 17 patients undergoing the repair of cervical esophageal or anastomotic stricture with a platysma myocutaneous flap. One of the patients in the group undergoing 12 miscellaneous procedures died 8 months after surgical intervention. All the survivors currently eat regular diets. CONCLUSIONS Intraluminal stenting can prevent the formation of caustic esophageal stricture. The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction. Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.
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Affiliation(s)
- Jing-Hai Zhou
- Department of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
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Abstract
Growth factors are members of a large functional group of polypeptide regulatory molecules that influence the biological activities of responsive cells. In the last decade, the use of a variety of growth factors as therapeutic agents to improve wound healing and the viability of ischemic skin flaps has aroused considerable interest. Here, we review the literature concerning the regulation of growth factors in a flap, the role of angiogenesis in flap survival, the effect of growth factors on the metabolism of a flap, and angiogenesis in flap prefabrication and maturation. The potential application of growth factors in gene therapies is also reviewed.
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Affiliation(s)
- Feng Zhang
- Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Zhang F, Zhu C, Oswald T, Lei MP, Lineaweaver WC. Porcine small intestinal submucosa as a carrier for skin flap prefabrication. Ann Plast Surg 2004; 51:488-92. [PMID: 14595185 DOI: 10.1097/01.sap.0000070648.65942.e6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The feasibility of porcine small intestinal submucosa (SIS) as a carrier in skin flap prefabrication was examined in this study. Thirty-eight rats were randomly divided into five groups. The saphenous vascular bundle was used as the vascular carrier. In group 1 (n = 8), an arteriovenous fistula was made by anastomosis of distal saphenous artery and vein. A SIS patch (1.5 x 2 cm2) was placed underneath the vascular bundle. In group 2 (n = 8), the vascular bundle was isolated and laid over the SIS patch. The distal saphenous vessels were ligated when the flap was raised. In group 3 (n = 8), an arteriovenous fistula was made without SIS implant. In group 4 (n = 8), the flap was raised with only the vascular bundle with the distal end ligated. After 2 weeks of maturation, the flap was raised with only the vascular bundle. In group 5 (n = 6), SIS was implanted and the flap including the SIS patch was raised and replaced without the vascular pedicles. The survival of the flaps and histology were evaluated at 5 days after flap replacement. The results showed that the average survival area in group 1 was 99% +/- 3% and the survival area in group 2 was 86% +/- 16%. The mean survival areas in group 3 and 4 were 60% +/- 9% and 25% +/- 10%, respectively. No flap survival was observed in the group 5. These were significantly lower than in groups 1 and 2 (p < 0.05, p < 0.01). Histology showed that SIS patch was incorporated into the adjacent connective tissue and increased amounts of neovascularization were seen between the collagenous sheets and dermis. In conclusion, this study demonstrated that porcine SIS can incorporate into the adjacent tissue and induce angiogenesis in flap prefabrication. This biomaterial can provide a scaffold for supporting and enhancing the survival of vascular prefabricated skin flap.
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Affiliation(s)
- Feng Zhang
- Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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22
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Chen Y, Chen H, Vranckx JJ, Schneeberger AG. Edge deepithelialization: a method to prevent leakage when tubed free skin flap is used for pharyngoesophageal reconstruction. Surgery 2001; 130:97-103. [PMID: 11436021 DOI: 10.1067/msy.2001.115354] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anastomosis leakage remains a major source of morbidity and mortality in patients who receive pharyngoesophageal reconstruction, especially when a free skin flap is used as the substitute. This makes free skin flaps less favored than other substitutes in pharyngoesophageal reconstruction. However, a free skin flap provides many advantages for pharyngoesophageal reconstruction and, in some circumstances, may be the only choice. To reduce the incidence of postoperative leakage, we developed a technical modification called edge-deepithelialization for skin flap to ensure a more secure anastomosis. METHODS Twenty-four patients who received tubed free skin flaps for cervical esophagus or hypopharynx reconstruction during a 7-year period were included in this study. Group 1 (n = 12) received flap edge-deepithelialization before undergoing the anastomosis, and Group 2 (n = 12) received the conventional anastomosis method. Preoperative nutritional status was evaluated by serum albumin level. All the patients were followed up for at least 1 year (1 approximately 14 years; mean, 7.3 years). Postoperative leakage was detected by clinical symptoms and signs or by routine esophagography. RESULTS Postoperative anastomosis leakage developed in 1 patient in Group 1 (8.3%) and 5 patients in Group 2 (41.67%). The difference in the leakage rate between these groups was of statistical significance (P =.0001). There were no significant differences in the preoperative serum albumin level noted between these 2 groups (t test, P >.05). Older age was not associated with a higher leakage rate. Among the 6 leakage cases, 1 was treated conservatively, and the other 5 needed an additional 1 to 5 procedures for the management of leakage. All the leakages were cured during the follow-up period. CONCLUSIONS With the flap edge deepithelialized, a more secure and reliable anastomosis can be obtained. This makes the free skin flap an easier and safer alternative in pharyngoesophageal reconstruction, especially when laparotomy and enteric flaps are contraindicated.
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Affiliation(s)
- Y Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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Abstract
A method for total esophageal reconstruction when intestinal options are no longer available is presented. The technique described utilizes the parascapular microsurgical free flap, which is tubed and interposed between the cervical esophagus and the gastric remnant in the abdomen. The technique involves a well-recognized microsurgical flap and may be added to the armamentarium for total esophageal reconstruction.
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Affiliation(s)
- R P Rand
- Department of Surgery, University of Washington, Seattle 98195-6410, USA.
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Chang VC, Chen HC, Hao SP, Liao CT. An adjunct to substernal dissection in esophageal reconstruction. Plast Reconstr Surg 2001; 108:260-1. [PMID: 11420537 DOI: 10.1097/00006534-200107000-00050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deveney CW, Soot S, Jobe B, Cohen JI, Anderson P, Wax MK, Wheatley M, Sheppard BC. Use of the radial forearm free tissue flap to treat persistent stricture after esophagogastrectomy. Am J Surg 2001; 181:459-62. [PMID: 11448443 DOI: 10.1016/s0002-9610(01)00599-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Persistent stricturing or anastomotic leakage at the cervical esophagogastric anastomosis can be a troublesome complication of gastric pull-up procedures. When the stricture is the result of ischemia of the stomach, the strictures are long and often not responsive to dilatation and require large operations such as jejunal interposition or replacement with colonic pull-up. In this report we describe the use of a radial forearm flap to patch strictures. METHODS The radial forearm flap is a fascia cutaneous flap taken from the forearm and based on the radial artery and its venae comitantes. The advantages of this flap are that it is thin and pliable, conforms easily, has excellent reliability due to the size of the feeding vessels, and has a relatively long pedicle. The vascular anastomosis can be made to several arteries and veins within the neck. The epithelial component can be made in sizes up to 10 by 20 cm. RESULTS We have used the radial forearm flap to patch strictures in 6 patients with persistent complex strictures in the cervical region after esophagectomy. Results were excellent in 4 patients (able to eat liquids and solids without problems) and good in 1 patient (liquids okay, some problem with solids), and 1 patient died postoperatively. Follow-up is 4 months to 7 years. CONCLUSIONS The radial forearm flap is an excellent option for handling persistent stricture after esophagogastrectomy. In many instances, this flap can be used in lieu of a jejunal interposition flap and obviates a laparotomy to harvest jejunum. The flap fits easily into the neck and conforms to the space.
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Affiliation(s)
- C W Deveney
- Oregon Health Sciences University and Veterans Administration Medical Center, Surgical Service-P3SURG, PO Box 1034, Portland, OR 97207, USA
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