Algorithmic Approach to Reconstruction of Esophageal/Hypopharyngeal Injuries After Anterior Cervical Spinal Fusion

Sharma, Abhay; Shabani, Sepehr; Khan, Mahnoor; Padhya, Tapan; Mifsud, Matthew

doi:10.1016/j.wneu.2021.08.114

Cited by 3 publications

(4 citation statements)

References 81 publications

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“…5 This etiology has a host of associated challenges including the presence of contaminated hardware in the setting of a potentially unstable cervical spine and poor quality of surrounding tissues. 6 Similar to the prior literature, the most common presenting symptoms of patients in our series was dysphagia and signs of infection from leak. 7 This diagnosis can often be delayed by months due to the nonspecific symptomatology and low index of suspicion.…”

Section: Discussionsupporting

confidence: 87%

“…Delayed perforation following spinal surgery is believed to result from chronic pressure necrosis of the nearby tissues 5 . This etiology has a host of associated challenges including the presence of contaminated hardware in the setting of a potentially unstable cervical spine and poor quality of surrounding tissues 6 . Similar to the prior literature, the most common presenting symptoms of patients in our series was dysphagia and signs of infection from leak 7 .…”

Section: Discussionsupporting

confidence: 64%

“…A systematic review by Sharma et al depicted an algorithmic approach to esophageal reconstruction after cervical spine fusion based on data from 173 patients across multiple studies. 6 Although the scope of the article is broad and includes conservative nonsurgical management in early leaks as well as surgical management of chronic leaks, the study highlights similarities to our approach. The authors advocate for a multilayer closure to decrease incidence of fistula whether or not the esophagus can be closed primarily.…”

Section: Discussionmentioning

confidence: 99%

“…Two patients required adjunct stabilization procedures. A systematic review by Sharma et al depicted an algorithmic approach to esophageal reconstruction after cervical spine fusion based on data from 173 patients across multiple studies 6 . Although the scope of the article is broad and includes conservative nonsurgical management in early leaks as well as surgical management of chronic leaks, the study highlights similarities to our approach.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Complications and Functional Outcomes After Esophageal Reconstruction with an Intact Larynx

Agarwal,

Philips,

Fiorella

et al. 2023

The Laryngoscope

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BackgroundEsophageal defects can result from primary pathologies such as malignancy or stricture, or secondary ones such as perforation due to trauma or iatrogenic injury. Techniques, management, and outcomes of reconstruction in this setting are poorly understood. Herein, we aim to highlight surgical outcomes in patients undergoing local and free flap reconstruction of esophageal defects in the setting of an intact larynx.MethodsRetrospective review of patients who underwent esophageal reconstruction with an intact larynx between 2009 and 2022 at our institution was performed.ResultsTen patients met inclusion criteria. Esophageal reconstruction was performed for extruded spinal hardware (n = 8), and esophageal stricture (n = 2). Four patients underwent reconstruction with free tissue transfer, and six with local pedicled flaps. There were no cases of flap failure, esophageal fistula, hematoma, or wound dehiscence. One patient had post‐operative bleeding requiring return to the operating room. Three patients had a postoperative wound infection, two of whom required washout. There were no unplanned 30‐day readmissions. At three months after operation, all patients who were not tube feed‐dependent prior to surgery returned to oral intake. Of the four patients who were tube feed‐dependent preoperatively, three were tolerating oral intake at nine months postoperatively. Nine patients (90%) had stable flexible laryngoscopy exams pre‐ and postoperatively with no voice changes.ConclusionsReconstruction of esophageal defects in the setting of an intact larynx can be challenging. In this series, surgical intervention with free tissue transfer and local pedicled flaps was effective in returning patients to oral intake with low long‐term morbidity.Level of Evidence4 Laryngoscope, 2023

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Section: Discussionsupporting

confidence: 87%