Risk factors for wound complications in head and neck reconstruction: 773 free jejunal reconstruction procedures after total pharyngolaryngoesophagectomy

Sugiyama, Narushi; Takao, Soshi; Suzuki, Etsuji; Kimata, Yoshihiro

doi:10.1002/hed.24874

Cited by 17 publications

(7 citation statements)

References 28 publications

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“…Furthermore, the current findings were consistent with their results. Sugiyama et al [ 16 ] reported that the use of an open drain, cardiovascular disease, and longer operation time are significant risk factors for abscess formation, fistula formation, and cervical flap necrosis. Reconstruction with a smaller flap size has a higher possibility of fistula formation [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Complications and Swallowing Function after Jejunal and Skin Flap Reconstruction for Hypopharyngeal Carcinoma—A Multicenter Retrospective Study

Tokashiki

Okamoto

Okada

et al. 2022

JCM

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This study compared the incidence of perioperative complications and swallowing function between free jejunal flap reconstruction and cutaneous free tissue flap construction. We included 223 patients who underwent hypopharyngeal reconstruction using free flap. At discharge, +the free jejunal flap was associated with a Functional Oral Intake Scale (FOIS) score of 1–6 in 132 cases (70%) and a score of 7 in 56 cases (30%). Regarding the cutaneous free tissue flaps, FOIS scores of 1–6 were observed in 18 cases (51%), and a score of 7 was noted in 17 cases (49%). Donor site complications occurred in 12% of the patients who underwent free jejunal flap procedures and in none of the patients who underwent cutaneous free tissue flap procedures. We found that the free jejunal flap had a regular dietary intake rate in 56 patients (30%), whereas cutaneous free tissue flaps had a regular dietary intake rate in 17 patients (49%). Cutaneous free tissue flaps had a significantly higher regular dietary intake rate at discharge and a significantly lower incidence of donor site complications than free jejunal flaps. In conclusion, free-flap reconstruction may be a better method than free jejunal flap reconstruction for the treatment of hypopharyngeal cancer.

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Section: Discussionmentioning

confidence: 99%

Postoperative Complications and Swallowing Function after Jejunal and Skin Flap Reconstruction for Hypopharyngeal Carcinoma—A Multicenter Retrospective Study

Tokashiki

Okamoto

Okada

et al. 2022

JCM

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“…A history of radiation to the neck increases the risk of wound complications after head and neck surgery. 15 , 16 PLCE cannot prevent devascularization at the level of tracheostomy and tracheostomy; these areas are unavoidably located in the irradiated field when preoperative radiation is performed. These mechanisms may explain the association between preoperative chemoradiotherapy and a higher incidence of P‐TBN in PLCE.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the P-TBN-present group tended to have more frequent preoperative chemoradiotherapy and salvage surgery in PLCE. A history of radiation to the neck increases the risk of wound complications after head and neck surgery 15,16. PLCE cannot prevent devascularization at the level of tracheostomy and tracheostomy; these areas are unavoidably located in the irradiated field when preoperative radiation is performed.…”

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confidence: 99%

Primary tracheobronchial necrosis after esophagectomy: A nationwide multicenter retrospective study in Japan

Sakai

Saeki

Sohda

et al. 2022

Annals of Gastroent Surgery

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Background The clinical features of postoperative primary tracheobronchial necrosis (P‐TBN; the necrosis without anastomotic leakage or other cervical and mediastinal abscess) remains unclear. This nationwide multicenter retrospective study first investigated the clinical features of P‐TBN after esophagectomy for upper aerodigestive tract cancer with a large cohort. Methods As a study of the Japan Broncho‐Esophagological Society, a nationwide questionnaire survey was conducted in 67 institutions. The clinical data of 6370 patients who underwent esophagectomy for laryngeal, pharyngeal, and esophageal cancer between 2010 and 2019 were collected. Grades of P‐TBN were defined as follows: Grade 1, mucosal necrosis; Grade 2, transmural bronchial wall necrosis without fistula or perforation; Grade 3, transmural bronchial wall necrosis with fistula or perforation. Results P‐TBN was observed in 48 (0.75%) of 6370 patients. The incidences of P‐TBN for pharyngo‐laryngo‐cervical esophagectomy (PLCE; n = 1650), total pharyngo‐laryngo‐esophagectomy (TPLE; n = 205), and subtotal esophagectomy (SE; n = 4515) were 2.0%, 5.4%, and 0.1%, respectively. The upper mediastinal LN dissection ( P = 0.016) and the higher level of the tracheal resection ( P = 0.039) were significantly associated with a higher grade of necrosis in PLCE and TPLE. Overall survival rates were significantly lower in patients with Grade 2 ( P = 0.009) and Grade 3 ( P = 0.004) than in those with Grade 1. Conclusion The incidence of TBN restricted to P‐TBN was lower than previously reported. Maintaining the tracheal blood flow is essential to prevent worsening P‐TBN, especially in PLCE and TPLE. Our new P‐TBN severity grade may predict the outcome of patients with P‐TBN.

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“…Although 1 patient developed anastomotic leakage caused by congested mucous membrane necrosis, the patient began oral intake on postoperative day 21 without symptoms of infection or inflammation. Sugiyama et al 1 reported that anastomotic leakage occurred in 11.3% of 773 Japanese patients. Our results were consistent with those reported, despite prior radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous radiation therapy increases the risk of anastomotic leakage, which may lead to abscess formation, pharyngocutaneous fistula formation, and carotid rupture. 1–3 The mesenteric flap was first described by Nahai et al 4 This procedure is useful for covering the anastomotic site and obliterating dead space. However, the mesenteric flap is covered by a serosal membrane, which acts as a barrier to adhesion and vascularization between the flap and the surrounding tissue.…”

Section: Introductionmentioning

confidence: 99%

Stripped Mesenteric Flap: A Novel Option for Preventing Anastomotic Leakage in Circumferential Pharyngeal Reconstruction

Fukunaga

Higashino

Oshima

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Summary:Reconstruction of a circumferential pharyngeal defect with a free jejunal flap is a well-established procedure. However, anastomotic leakage often occurs, which can lead to abscess formation, pharyngocutaneous fistula formation, and carotid rupture. Previous reports have described covering the anastomotic site with a mesenteric flap to prevent anastomotic leakage. However, the mesentery is covered by a serosal membrane, which interferes with adhesion and vascular communication. Therefore, we stripped off the serosal membrane to accelerate adhesion to the anastomotic site. We retrospectively studied patients who had a history of radiotherapy and who had received a stripped mesenteric flap in a circumferential pharyngeal reconstruction procedure. We collected the following data: operative time, blood loss, postoperative complications, interval to resumption of oral intake, and duration of hospital stay. We obtained data for 11 patients. The jejunal flap failed in one patient because of arterial thrombosis. One of the other 10 patients developed anastomotic leakage caused by congested mucous membrane necrosis. The patient was treated conservatively and showed no clinical symptoms of infection or inflammation. The 9 remaining patients had no anastomotic leakage. In the present series, although anastomotic leakage was observed in one of 10 patients who underwent circumferential pharyngeal reconstruction using a stripped mesenteric flap, the severity of the leakage was minimized.

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Risk factors for wound complications in head and neck reconstruction: 773 free jejunal reconstruction procedures after total pharyngolaryngoesophagectomy

Abstract: Our findings suggest that use of an open drain, cardiovascular disease, and a longer operation time are significant risk factors for abscess formation, fistula formation, and cervical skin flap necrosis, respectively.

Cited by 17 publications

References 28 publications

Postoperative Complications and Swallowing Function after Jejunal and Skin Flap Reconstruction for Hypopharyngeal Carcinoma—A Multicenter Retrospective Study

Postoperative Complications and Swallowing Function after Jejunal and Skin Flap Reconstruction for Hypopharyngeal Carcinoma—A Multicenter Retrospective Study

Primary tracheobronchial necrosis after esophagectomy: A nationwide multicenter retrospective study in Japan

Stripped Mesenteric Flap: A Novel Option for Preventing Anastomotic Leakage in Circumferential Pharyngeal Reconstruction

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