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Yildirim MEC, Mousavi SA, Chen S, Lu T, Weng H, Chen H. Development of a benign colon tumour in the free colon flap after the oesophageal reconstruction. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mehmet Emin Cem Yildirim
- Department of Plastic Surgery Demiroglu Science Unıversity Florence Nightingale Hospital Istanbul Turkey
| | | | - Shih‐Heng Chen
- Department of Plastic Surgery Chang Gung Memorial Hospital Taipei Taiwan
| | - Ting‐Yu Lu
- Department of Thoracic Surgery China Medical University Hospital Taichung Taiwan
| | - Hui‐ching Weng
- Institute of Gerontology National Cheng Kung, University Tainan Taiwan
| | - Hung‐chi Chen
- Department of Plastic Surgery China Medical University Hospital Taichung Taiwan
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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.
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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
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Postoperative Management After Total Pharyngolaryngectomy Using the Free Ileocolon Flap: A 5-Year Surgical Intensive Care Unit Experience. Ann Plast Surg 2021; 84:68-72. [PMID: 31246671 DOI: 10.1097/sap.0000000000001953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Management after total pharyngolaryngectomy with free ileocolon flaps can be challenging. Adequate postoperative surgical guidelines are essential to avoid complications. Factors, such as agitation, hypotension, or prolonged mechanical ventilation, might compromise final outcomes. Herein, we describe our experience in the early postoperative care of patients after total pharyngolaryngectomy with immediate reconstruction using the free ileocolon flap. METHODS This is a retrospective review of all patients who underwent total pharyngolaryngectomy and immediate reconstruction using the free Ileocolon flap. Demographics, etiology of resection, neoadjuvant therapy, surgical time, method of sedation, postoperative use of vasopressors, length of intensive care unit (ICU) stay, time of discontinuation of mechanical ventilation, and complications were recorded and analyzed. RESULTS Between 2010 and 2015, a total of 34 patients underwent total pharyngolaryngectomy and immediate reconstruction using the free Ileocolon flap. The most common cause of total pharyngolaryngectomy was cancer. Twenty-eight patients had neoadjuvant therapy (radiation). The average surgical time was 11.5 hours (range, 8-14.5 hours), average length of ICU stay was 3 days (range, 2-15 days) with an average time for mechanical ventilation cessation of 3 days (range, 1-20 days). Midazolam and dexmedetomidine were the most common sedatives used during surgery and in the ICU period. Three patients required vasopressors due to hypotension, 2 had unplanned self-extubation from the tracheostomy site, 2 experienced postoperative bleeding, 1 had pneumonia, 4 required unplanned return to the operating room, 2 had partial flap loss, and 1 had complete flap loss. CONCLUSIONS Overall, a majority of patients recovered well postoperatively with minimal complications and low rate of reoperation. Our research provides a foundation to develop a risk-stratified approach to determine the need for an ICU admission or early transfer to floor care.
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Gillespie J. Imaging of the post-treatment neck. Clin Radiol 2020; 75:794.e7-794.e17. [PMID: 32690240 DOI: 10.1016/j.crad.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
Post-treatment imaging of the neck is complex. It is important to have an understanding of the expected treatment related appearances as well as the possible complications. Common findings after radiation therapy include generalised soft-tissue oedema and thickening of the skin and platysma muscle. There are a number of complications of radiation that may be seen on imaging, including osteoradionecrosis, chondronecrosis, and accelerated atherosclerosis. Surgical procedures are variable depending on the primary tumour site and extent. The use of flap reconstructions can further complicate the imaging appearances. Any new nodule of enhancement or bone/cartilage erosion should raise concern for tumour recurrence. It is also important to assess for nodal recurrence. A standardised approach to reporting may help to increase accuracy and guide treatment decisions.
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Affiliation(s)
- J Gillespie
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia; Faculty of Medicine, University of Queensland, Level 6, Oral Health Centre, Herston Road, Herston, QLD, 4006 Australia.
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Maier A, Lindenmann J, Hammer G, Swatek P, Fink-Neuboeck N, Fediuk M, Thurnher D, Smolle-Juettner FM. Interposition of Retrosternal Pedicled Jejunum After Hypopharyngolaryngo-Esophagogastrectomy. Ann Thorac Surg 2019; 108:e217-e219. [PMID: 31181201 DOI: 10.1016/j.athoracsur.2019.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
Reconstruction of the upper gastrointestinal tract presents a surgical challenge after esophagogastrectomy, especially when it includes hypopharyngolaryngectomy. Reconstruction is generally undertaken with interposed colon as a substitute conduit, but it carries several risks. Alternative reconstruction of the foregut with pedicled retrosternal jejunum anastomosed at the level of the base of the tongue is described.
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Affiliation(s)
- Alfred Maier
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Joerg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Georg Hammer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Paul Swatek
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Nicole Fink-Neuboeck
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Melanie Fediuk
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Dietmar Thurnher
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
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Lo Torto F, Manrique OJ, Ciudad P, Agko M, Chung JC, Chen HC. Pearls and pitfalls of voice reconstruction after pharyngolaryngectomy using the ileocolon free flap. Microsurgery 2016; 37:453-454. [PMID: 27135992 DOI: 10.1002/micr.30059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/07/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Federico Lo Torto
- Sapienza University, Valdoni, Unit of Plastic surgery, viale del policlinico Rome, Rome, IT 00100
| | - Oscar J Manrique
- China Medical University Hospital, plastic surgery 2 Yuh-Der Road Taichung, TW 40447
| | - Pedro Ciudad
- China Medical University Hospital, plastic surgery 2 Yuh-Der Road Taichung, TW 40447
| | - Mouchammed Agko
- China Medical University Hospital, plastic surgery 2 Yuh-Der Road Taichung, TW 40447
| | - Joseph Ck Chung
- China Medical University Hospital, plastic surgery 2 Yuh-Der Road Taichung, TW 40447
| | - Hung-Chi Chen
- China Medical University Hospital, plastic surgery 2 Yuh-Der Road Taichung, TW 40447
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Ruiz-Moya A, Segura-Sampedro JJ, Sicilia-Castro D, Carvajo-Pérez F, Gómez-Cía T, Vázquez-Medina A, Ibáñez-Delgado F. Chimeric Anterolateral Thigh Flap for Total Thoracic Esophageal Reconstruction. Ann Thorac Surg 2015; 101:338-42. [PMID: 26694271 DOI: 10.1016/j.athoracsur.2015.02.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/05/2015] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Abstract
Gastric pull-up is generally the first choice for a total thoracic esophageal reconstruction. Malfunction of this gastric conduit is uncommon, but devastating when it occurs: it causes marked comorbidity to the patient, preventing oral intake and worsening quality of life. Secondary salvage thoracic esophageal reconstruction surgery is usually performed with free or pedicled jejunum flaps or colon interposition. We present a case of a total thoracic esophageal reconstruction with an externally monitored chimeric anterolateral thigh flap, extending from the cervical esophagus to the retrosternal gastroplasty remnant. Intestinal reconstructive techniques were not an available option for this patient.
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Affiliation(s)
- Alejandro Ruiz-Moya
- Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospital, Seville, Spain.
| | | | - Domingo Sicilia-Castro
- Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Francisco Carvajo-Pérez
- Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Tomás Gómez-Cía
- Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospital, Seville, Spain
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Farhadieh RD, Morrison WA. Pharyngeal reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Perrone F, Nitto A, Tang YB, Chen SH, Chen HC. Three uses of an extra length of jejunum in pharyngo-oesophageal reconstruction with free jejunal flap. J Plast Reconstr Aesthet Surg 2013; 66:16-22. [DOI: 10.1016/j.bjps.2012.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/21/2012] [Accepted: 08/03/2012] [Indexed: 12/01/2022]
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Kim Evans KF, Mardini S, Salgado CJ, Chen HC. Esophagus and hypopharyngeal reconstruction. Semin Plast Surg 2012; 24:219-26. [PMID: 22550442 DOI: 10.1055/s-0030-1255339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article reviews the literature on esophageal reconstruction. The most common methods used are gastric pull-up, pectoralis major flap, colon interposition, fasciocutaneous flaps (radial forearm free flap or anterolateral thigh flap), and free jejunum and colon flaps. The stricture rates, fistula rates, morbidity, and mortality of each flap are reviewed.
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Chen H, Kuo H, Chung K, Chen S, Tang Y, Su S. Quality improvement of microsurgery through telecommunication—the postoperative care after microvascular transfer of intestine. Microsurgery 2012; 32:96-102. [PMID: 22267277 DOI: 10.1002/micr.20965] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Hung‐Chi Chen
- Plastic Surgery, China Medical Hospital, China Medical University, Taiwan
| | - Hsin‐Chih Kuo
- Health Management, I‐Shou University, Kaohsiung County, Taiwan
| | - Kuo‐Piao Chung
- Health Policy and Management, National Taiwan University, Taiwan
| | - Shih‐Heng Chen
- Plastic Surgery, National Taiwan University Hospital, Taiwan
| | - Yueh‐Bih Tang
- Plastic Surgery, National Taiwan University Hospital, Taiwan
| | - Syi Su
- Health Policy and Management, National Taiwan University, Taiwan
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Voice restoration after laryngectomy. Plast Reconstr Surg 2011; 127:997-998. [PMID: 21285819 DOI: 10.1097/prs.0b013e318200ac51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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