The objective of the study was to compare outcomes of emergency esophagogastrectomy (EGT) and total gastrectomy with immediate esophagojejunostomy (EJ) in patients with full-thickness caustic necrosis of the stomach and mild esophageal injuries. After caustic ingestion, optimal management of the esophageal remnant following removal of the necrotic stomach remains a matter of debate. Between 1987 and 2012, 26 patients (men 38%, median age 44 years) with isolated transmural gastric necrosis underwent EGT (n = 14) or EJ (n = 12). Early and long-term outcomes of both groups were compared. The groups were similar regarding age (P = 0.66), gender (0.24), and severity of esophageal involvement. Functional success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. Emergency morbidity (67% vs. 64%, P = 0.80), mortality (17% vs. 7%, P = 0.58), and reoperation rates (25% vs.14%, P = 0.63) were similar after EJ and EGT. One patient (8%) experienced EJ leakage. One patient in the EJ group and 13 patients in the EGT group underwent esophageal reconstruction (P < 0.0001). Aggregate in hospital length of stay was significantly longer in patients who underwent EGT (median 83 [33-201] vs. 36 [10-82] days, P = 0.001). Functional success after EJ and EGT was similar (90% vs.69%, P = 0.34). Immediate EJ can be safely performed after total gastrectomy for caustic injuries and reduces the need of further esophageal reconstruction.
Material and Methods: An IRB approved retrospective review was performed between 2010 and 2013 to identify patients undergoing foot and ankle flaps. Ninety-two patients undergoing a total of 94 flaps were identified. Patient characteristics and outcomes were evaluated and compared using descriptive statistics and Student's t-test. Results: Fifty-five patients underwent 56 free flap reconstructions. Thirty-seven patients underwent 38 local flap reconstructions. The mean age between groups did not differ significantly (55 vs 57 yo, free vs local; NS). Patients that underwent free flaps had a significantly higher rate of having 3 or more co-morbidities (49% vs 16%, free vs local; p<0.05). Patients that underwent free flaps had significantly larger wound defects (74 vs 14 cm squared, free vs local; p<0.05) and were significantly more likely to have sustained a recent trauma (46 vs 7%, free vs local; p<0.05), Figure 1. The rate of flap loss and eventual BKA did not differ between the 2 groups (Flap loss: 9 vs 11%, free vs local; NS and BKA: 6 vs 5%, free vs local; NS). Conclusion: Free and local flaps offer excellent coverage in select patients. Free flap patients were more likely to be ill, have larger defects from trauma associated wounds. In contrast, local flap patients were healthier and had wounds more commonly associated with elective orthopedic procedures or cancer resections. Still, both groups have relatively high rates of flap loss and eventual amputations, indicating the complexity of foot and ankle reconstruction.
Material and Methods: An IRB approved retrospective review was performed between 2010 and 2013 to identify patients undergoing foot and ankle flaps. Ninety-two patients undergoing a total of 94 flaps were identified. Patient characteristics and outcomes were evaluated and compared using descriptive statistics and Student's t-test. Results: Fifty-five patients underwent 56 free flap reconstructions. Thirty-seven patients underwent 38 local flap reconstructions. The mean age between groups did not differ significantly (55 vs 57 yo, free vs local; NS). Patients that underwent free flaps had a significantly higher rate of having 3 or more co-morbidities (49% vs 16%, free vs local; p<0.05). Patients that underwent free flaps had significantly larger wound defects (74 vs 14 cm squared, free vs local; p<0.05) and were significantly more likely to have sustained a recent trauma (46 vs 7%, free vs local; p<0.05), Figure 1. The rate of flap loss and eventual BKA did not differ between the 2 groups (Flap loss: 9 vs 11%, free vs local; NS and BKA: 6 vs 5%, free vs local; NS). Conclusion: Free and local flaps offer excellent coverage in select patients. Free flap patients were more likely to be ill, have larger defects from trauma associated wounds. In contrast, local flap patients were healthier and had wounds more commonly associated with elective orthopedic procedures or cancer resections. Still, both groups have relatively high rates of flap loss and eventual amputations, indicating the complexity of foot and ankle reconstruction.
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