Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature

Murray, Dylan J.; Novak, Christine B.; Neligan, Peter C.

doi:10.1016/j.bjps.2007.09.030

Cited by 109 publications

(135 citation statements)

References 49 publications

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“…The most significant advantage of fasciocutaneous free flaps is the avoidance of intra-abdominal dissection and possible complications such as abdominal wound dehiscence, bowel obstruction, prolonged ileus, gastrointestinal bleeding, and abdominal wall hernia. 7 Unfortunately, free tissue reconstruction is not immune to morbidity. Although visceral transpositions make up the majority of esophageal conduit reconstructions providing abundant literature detailing successful management of esophagogastric and esophagocolonic anastomotic leaks.…”

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confidence: 99%

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

Dodd¹,

Goodnight²,

Pu³

2010

Annals of Plastic Surgery

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Free visceral and, more recently, free fasciocutaneous flaps are becoming increasingly common for esophageal reconstruction. However, complications of free flap conduit ischemia, specifically anastomotic leak have not been frequently discussed in the literature. This article provides a detailed description of total esophageal reconstruction with an 18 x 8.5 cm tube free radial forearm flap. A clinically significant cervical anastomosis leak was contained and healed with an innovative surgical rearrangement of local muscle flaps and closed suction drainage. We discuss the literature associated with cervical anastomotic leaks after visceral reconstruction and adapt those principles to the unique physiology of free fasciocutaneous flaps to develop a simple but reliable salvage option. This approach should be considered by reconstructive surgeons when helping other surgeons to manage an anastomotic leak after a cervical esophageal reconstruction in a similar setting.

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confidence: 99%

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

Dodd¹,

Goodnight²,

Pu³

2010

Annals of Plastic Surgery

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“…Murray et al reported an overall fistula rate of 13% for free fasciocutaneous flaps and 9.4% for free jejunal flaps. 10 Several flap modifications have been described to minimize the risk of postoperative fistulae, particularly in patients with a history of radiotherapy. Variations of the mesenteric wrap, which uses the mesentery associated with the jejunum to reinforce the jejunal anastomosis, have been described to decrease fistula rates.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it eliminates the need for a vertical suture line required by tubed fasciocutaneous flaps and has been show in prior studies to have a lower fistula rate. 10,11 Classically, fistulae are treated with pedicled muscle flaps after the diagnosis has been made and failed to resolve with conservative treatment. However, several techniques have been described to prevent the formation of fistulae in patients who received radiotherapy.…”

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confidence: 99%

The Use of the Sternocleidomastoid Flap Helps Reduce Complications After Free Jejunal Flap Reconstructions in Total Laryngectomy and Cervical Esophagectomy Defects

Moody

Hunter²,

Nazerali³

et al. 2016

Annals of Plastic Surgery

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“…13 Compared to other publications, we did not see a correlation between radiation therapy or chemoradiation therapy and stricture formation. 11,12,14,15 Treatment with chemoradiation, radiation alone, or surgery did not increase the odds of stricture formation. The majority of patients received their radiation therapy at outside establishments not associated with our tertiary care center; therefore, dosages of radiation and fraction frequency were unknown for the majority of this patient population.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Stricture Formation Post‐laryngectomy

Sweeny¹,

Golden²,

Rosenthal³

et al. 2011

Otolaryngol.--head neck surg.

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Objective-Postlaryngectomy stricture formation and dysphagia negatively affect quality of life and result in nutritional compromise. Understanding risk factors and successful treatment strategies may improve treatment outcomes.Study Design-Historical cohort study. Setting-Tertiary care medical center.Subjects and Methods-Patients at a tertiary care center who underwent a total laryngectomy between 2003 and 2009 (N = 263) were evaluated in a retrospective manner. Patient demographics, comorbidities, tobacco and alcohol usage, dietary outcomes, feeding tube dependence, and treatment modalities were assessed. Management strategies and outcomes were evaluated.Results-Strictures developed in 19% (n = 49) of patients, and the majority (82%) occurred in the first year. Incidences of stricture formation were similar for primary (19%) and salvage laryngectomy (19%) patients. Patients undergoing salvage laryngectomy were 2 times more likely to be reconstructed with a free flap, whereas those undergoing a primary laryngectomy were 3 times more likely to be closed primarily. Tubed flap reconstruction significantly increased the incidence of stricture formation compared to primary closure (P = .02) in salvage laryngectomy cases. In primary laryngectomy patients, stricture formation did not correlate with flap reconstruction (P = .34) or adjuvant radiation therapy (P = .79). Patients who required a single dilation had better dietary outcomes compared to patients who required serial dilations (P = .14). There was no difference in overall disease-free survival in primary vs salvage laryngectomy patients (P = .95). © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2012Corresponding Author: Eben L. Rosenthal, MD, University of Alabama at Birmingham, Division of Otolaryngology, Volker Hall G082, 1670 University Blvd, Birmingham, AL 35233, USA, oto@uab.edu. Reprints and permission: sagepub.com/journalsPermissions.nav Author Contributions Larissa Sweeny, conception and design, analysis and interpretation of data, drafting the article, final approval of the version to be published; J. Blake Golden, conception and design, analysis and interpretation of data, editing of the article, final approval of the version to be published; Hilliary N. White, conception and design, analysis and interpretation of data, editing of the article, final approval of the version to be published; J. Scott Magnuson, conception and design, analysis and interpretation of data, editing of the article, final approval of the version to be published; William R. Carroll, conception and design, analysis and interpretation of data, editing of the article, final approval of the version to be published; Eben L. Rosenthal, conception and design, analysis and interpretation of data, drafting the article, final approval of the version to be published. Conclusion-Rates of stricture formation were the same in patients undergoing salvage compared to primary total laryngectomy. Keywordsstricture; squamous cell carcinoma; head and neck; survival A...

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Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature

Cited by 109 publications

References 49 publications

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

The Use of the Sternocleidomastoid Flap Helps Reduce Complications After Free Jejunal Flap Reconstructions in Total Laryngectomy and Cervical Esophagectomy Defects

Incidence and Outcomes of Stricture Formation Post‐laryngectomy

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