Comparative Evaluation in Pharyngo-oesophageal Reconstruction: Radial Forearm Flap compared with Jejunal Flap. A 10-year experience

Nakatsuka, Takashi; Harii, Kiyonori; Asato, Hirotaka; Ebihara, Satoshi; Yoshizumi, Takashi; Saikawa, Masahisa

doi:10.1080/02844319850158651

Cited by 98 publications

(74 citation statements)

References 11 publications

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“…[27][28][29] The discussion about the ideal method for reconstruction of the cervical oesophagus is still ongoing. 27,29,30 However, a high success and low complication rate has been reported for both methods. [22][23][24][25][26][27][28][29] The lateral island trapezius myocutaneous flap, 31 the extended submental island flap, 32 and the pectoralis major myocutaneous flap 33,34 are reported to be alternative methods for cervical oesophageal reconstruction, and might be suitable also in trauma situations.…”

Section: Discussionmentioning

confidence: 99%

Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature

Erdmann

et al. 2003

Spinal Cord

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Study design: Single-subject (male, 16 years of age) case. Objectives: To demonstrate a suitable method for oesophageal repair after perforation as a complication of anterior spinal fusion in an individual with quadriplegia, and to review the literature on oesophageal perforation and repair. Setting: University hospital, large trauma centre with departments for spinal injuries and reconstructive surgery in Germany. Methods: A free jejunal graft used for oesophageal reconstruction in a post-traumatic situation after a complicated treatment course in a C6 quadriplegic patient. Results: A protuberant loose screw of the titanium plate after anterior spinal fusion perforated the oesophagus. Imbricating sutures and a fascia lata patch were insufficient to repair the oesophageal leakage. An 8 cm long segment of the cervical oesophagus including a fistula had to be excised, and a free microsurgical jejunal flap was used for restitution of continuity. The jejunal vessels were connected to the superior thyroid artery and external jugular vein. At 1 week after the oesophageal repair, an enteral contrast study showed a small amount of contrast medium leaking at the oesophago-pharyngeal anastomosis. A percutaneous gastric tube was inserted, and oral feeding was limited to tea and still water for 4 weeks. The further course was uneventful. Conclusions: Oesophageal perforation is a rare but recognized complication after cervical spine surgery, which can mostly be managed using secondary suture techniques. The free jejunal flap is a reliable and innovative tool in the particularly complex situation of a segmental oesophageal loss. It should be considered in similar cases to reconstruct oesophageal continuity or to treat stricture and fistula formations.

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Section: Discussionmentioning

confidence: 99%

Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature

Erdmann

et al. 2003

Spinal Cord

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“…Jejuna also have a large and adequate vasculature, enabling freedom to select mesenteric vessels and a greater range of safety margin for tumor resection by harvesting a sufficient length of intestinal segment. 36,37) Furthermore, an anastomotic procedure after harvest shows little impact on the digestive system, with a low rate of surgical complications. Thus, the goal of the free jejunum graft is a single stage reconstruction with a low complication rate, such as leakage and stenosis, short hospital stay and early restoration of swallowing.…”

Section: Hypopharynxmentioning

confidence: 99%

Current Reconstructive Techniques Following Head and Neck Cancer Resection Using Microvascular Surgery

Kanazawa

Sarukawa

Fukushima

et al. 2011

Annals of Vascular Diseases

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Various techniques have been developed to reconstruct head and neck defects following surgery to restore function and cosmetics. Free tissue transfer using microvascular anastomosis has transformed surgical outcomes and the quality of life for head and neck cancer patients because this technique has made it possible for surgeons to perform more aggressive ablative surgery, but there is room for improvement to achieve a satisfactory survival rate. Reconstruction using the free tissue transfer technique is closely related to cardiovascular surgery because the anastomosis techniques used by head and neck surgeons are based on those of cardiovascular surgeons; thus, suggestions from cardiovascular surgeons might lead to further development of this field. The aim of this article is to present the recent general concepts of reconstruction procedures and our experiences of reconstructive surgeries of the oral cavity, mandible, maxilla, oropharynx and hypopharynx to help cardiovascular surgeons understand the reconstructions and share knowledge among themselves and with neck surgeons to develop future directions in head and neck reconstruction.

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“…Two-stage operations such as the deltopectoral flap technique, colon interposition, reversed gastric tubes, local and regional skin flaps have to a large extent been replaced by one-stage procedures such as gastric pull-up or reconstruction with free fasciocutaneus microvascular transplants [2,3,4,5,6,7,8,9,10,11]. The use of free jejunal transplants has been popularized during the last decades and advocated by many surgeons [12,13,14,15,16,17,18].…”

Section: Introductionmentioning

confidence: 99%

Functional Long-Term Outcome of a Free Jejunal Transplant Reconstruction following Chemoradiotherapy and Radical Resection for Hypopharyngeal and Proximal Oesophageal Carcinoma

Bergquist

Ejnell²,

Fogdestam³

et al. 2004

Dig Surg

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Background/Aims: To evaluate the functional outcome of a reconstruction by a free vascularized jejunal transplant combined with a voice prosthesis after chemoradiotherapy and surgery for proximal oesophageal or hypopharyngeal cancer. Methods: Seven patients (6 men, mean age 52 years, range 28–70) with squamous cell cancer in the proximal oesophagus (n = 6) or the hypopharynx received preoperative chemoradiotherapy (40.8 Gy, cisplatinum and 5-FU) followed by a circumferential pharyngolaryngectomy and resection of the proximal oesophagus. A single-stage reconstruction was carried out with a free jejunal transplant using a microsurgical technique. A tracheojejunal puncture and insertion of a voice prosthesis (Provox I) was performed after 3 months in suitable cases. Results: All operations had a per- and postoperative uneventful course. Five patients were alive after a mean follow-up time of 5 years and 7 months after surgery (range 3 years 4 months to 7 years 10 months), while 2 patients died from metastases within 2 years after surgery. Postoperative examination showed histopathological down-staging in all cases. Relief of dysphagia was achieved in most cases. Good or average speech was recorded in 3 patients. Conclusion: Reconstruction after radical resection for proximal oesophageal and hypopharyngeal cancer can be carried out with low mortality, acceptable morbidity and a promising functional outcome.

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Comparative Evaluation in Pharyngo-oesophageal Reconstruction: Radial Forearm Flap compared with Jejunal Flap. A 10-year experience

Cited by 98 publications

References 11 publications

Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature

Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature

Current Reconstructive Techniques Following Head and Neck Cancer Resection Using Microvascular Surgery

Functional Long-Term Outcome of a Free Jejunal Transplant Reconstruction following Chemoradiotherapy and Radical Resection for Hypopharyngeal and Proximal Oesophageal Carcinoma

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