Externalized double monitoring skin paddles for buried anterolateral thigh flap in pharyngoesophageal reconstruction

Tseng, Wan Ling; Hung, Kuo-Shu; Tsai, Chin-Ho; Lee, Yao Chou

doi:10.1002/micr.30399

Cited by 4 publications

(3 citation statements)

References 4 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this context, fascio-cutaneous flaps also allow the design of a double island flap based on several perforators, one for the reconstruction of the esophageal tract and the other for the neck coverage (Figure 2). Finally, this procedure also allows the evaluation of the viability of the tubulized submerged flap [8]. To date, there is a lack of recent studies in the literature that offer a thorough examination of the clinical attributes of different treatment options, coupled with actionable insights to aid healthcare practitioners in their decision-making process.…”

Section: Introductionmentioning

confidence: 99%

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

Ramella,

Ferrari,

Novati

et al. 2024

Preprint

View full text Add to dashboard Cite

Background. Cervical esophageal reconstruction is vital for improving the quality of life in cancer surgery patients. Microsurgery is crucial, providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors' experience and the literature review. Methods. We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques employed for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative details. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results. We treated 13 cases of secondary esophageal reconstructions from 2011 to 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed Radial Forearm Flap (RFF), and 1 a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced post-op stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in a RFF patient with a history of radiotherapy and completion lymph node dissection. Conclusions. Cervical esophageal reconstruction significantly impacts patients' quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable, but burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

Ramella,

Ferrari,

Novati

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…In this context, fascio-cutaneous flaps also allow the design of a double-island flap based on several perforators, one for the reconstruction of the esophageal tract and the other for the cutaneous coverage of the neck (Figure 2). Finally, this procedure also allows the evaluation of the viability of tubularized submerged flaps [11]. To date, the literature lacks recent studies that thoroughly examine the clinical attributes of different treatment options, along with practical insights to aid healthcare practitioners in their decision-making process.…”

Section: Introductionmentioning

confidence: 99%

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

Ramella,

Ferrari,

Novati

et al. 2024

JCM

View full text Add to dashboard Cite

Background: Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors’ experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients’ quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.

show abstract

“…1 These flaps are frequently employed in head and neck surgery for pharyngeal, esophageal and mandibular reconstruction. 2,3 In this context, an efficient free flap monitoring during the early postoperative period has the purpose of early detecting any vascular crisis, increasing the salvage rate. Many flap monitoring techniques have been developed over time, including clinical monitoring, laser Doppler flowmetry, implantable Doppler probes and near-infrared spectroscopy (NIRS).…”

Section: Introductionmentioning

confidence: 99%

Near-Infrared Spectroscopy for Continuous Noninvasive Monitoring of Free Flap in Head and Neck Reconstruction: Systematic Review of the Literature and Personal Experience

Festa,

Costantino,

Pace

et al. 2023

Surg Innov

View full text Add to dashboard Cite

Background Buried free flaps represent a reconstructive challenge concerning monitoring of vitality, which is fundamental for an early detection of flap failure and prompt surgical salvage. Many flap monitoring techniques have been developed over time, and there is still no consensus concerning the best monitoring technique for buried reconstructions. Methods We performed a systematic review of the literature on NIRS monitoring for head and neck free flaps. Moreover, we presented a case of orbital reconstruction through a buried free myo-fascial anterolateral tight flap (ALTF) in which postoperative monitoring was performed by means of NIRS. Results Four studies were included with a total of 200 monitored head and neck free flap reconstructions. Flap survival was reported in 96.5% of studies (n = 193/200) with a 3.5% of total flap failure rate (n = 7/200). We monitored the buried myo-fascial ALTF for 7 post-operative days measuring a regional oxygen saturation (rSO2) ranging from 55% to 72% (mean = 66%). Conclusions This device appeared to be an efficient choice for monitoring buried flaps, thanks to its ability to measure tissue perfusion deep under the skin, to the continuous availability of recorded data on the monitor, and to its low impact on the patient. Further prospective studies are advised in order to standardize this monitoring technique and define warning values.

show abstract

Externalized double monitoring skin paddles for buried anterolateral thigh flap in pharyngoesophageal reconstruction

Cited by 4 publications

References 4 publications

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

Near-Infrared Spectroscopy for Continuous Noninvasive Monitoring of Free Flap in Head and Neck Reconstruction: Systematic Review of the Literature and Personal Experience

Contact Info

Product

Resources

About