Surgical Salvage of Failed Esophageal Reconstruction Attempted with Gastric Pedicle

Yamamoto, Yuhei; Minakawa, Hidehiko; Okushiba, Shunichi; Motohara, Toshiji

doi:10.1055/s-2007-1000237

Cited by 7 publications

(4 citation statements)

References 1 publication

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“…Stricture of the alimentary tract was observed in 1 patient (patient 8). Thirteen of 16 patients had an almost normal diet, but 3 could eat only gruel (patients 8,9,12). No patient had mechanical small-bowel obstruction.…”

Section: Resultsmentioning

confidence: 99%

Secondary Reconstruction of Failed Esophageal Reconstruction

Okazaki¹,

Asato²,

Takushima³

et al. 2005

Annals of Plastic Surgery

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Between June 1992 and November 2002, 17 patients underwent secondary reconstruction of circumferential esophageal defects due to the failure of immediate reconstruction following ablation of thoracic esophageal cancer. Salvage reconstruction was achieved using free jejunal transfer in 13 patients (including long segment with double vascular pedicle in 2 cases), skin and/or musculocutaneous flap in 2 cases, and jejunal pull-up in 2 cases. In 5 patients, the second salvage surgery was required because of the failed first salvage. However, successful restoration of the esophagus and peroral alimentation was finally achieved in 16 of 17 patients, except 1 patient with several salvage operations using skin and musculocutaneous flap because the gut was unusable. We concluded that the preferred first choice for salvage restoration is free jejunal transfer. If the length of the esophageal defect is extensive, colonic interposition or jejunal pedicle with microvascular anastomosis for supercharging is the next option. If these procedures cannot be used, the transfer of a long jejunal segment with double vascular pedicles is recommended. Reconstruction using skin and/or musculocutaneous flap is the final option. As primary wound closure is often difficult in secondary reconstruction of the esophagus, a pectoralis major musculocutaneous flap is reliable to cover the reconstructed esophagus because skin flaps located in the neck region may be damaged by neck dissection or irradiation, and coverage of the anastomosis with muscle between the digestive tracts is effective to prevent leakage.

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Section: Resultsmentioning

confidence: 99%

Secondary Reconstruction of Failed Esophageal Reconstruction

Okazaki¹,

Asato²,

Takushima³

et al. 2005

Annals of Plastic Surgery

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“…Primary closure is often complicated by scar formation and fibrosis of the surrounding skin. Several authors have advocated resurfacing with healthy skin or well‐vascularized tissue to prevent fistula formation and compression of the conduit . Flaps used for such purposes include pectoralis major musculocutaneous flaps, pectoral fasciocutaneous flaps, and platysma musculocutaneous flaps.…”

Section: Discussionmentioning

confidence: 99%

Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction

et al. 2013

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Secondary reconstruction of thoracic esophageal defects is a challenging problem for microsurgeons. Because of previous surgeries and coexisting disease, gastric pull-up, and creation of a pedicled colon conduit are often impossible. Transfer of a supercharged pedicled jejunum flap or free jejunal interposition is usually the last resort; however, identifying appropriate recipient vessels and adequately covering the reconstructive conduit are often difficult. We performed secondary thoracic esophageal reconstruction with combined use of the cephalic vein as a recipient vein and the pectoralis major muscle flap for coverage in three patients. Two patients underwent transfer of a supercharged pedicled jejunum flap, and the other patient underwent free jejunal interposition. No wound complications occurred, and all patients could resume oral intake. The cephalic vein is a more reliable recipient vein than is the internal mammary vein. The skin graft-covered pectoralis major muscle flap provides secure external coverage to prevent anastomotic leakage even in complicated cases. Combined use of the cephalic vein and the skin graft-covered pectoralis major muscle flap is a versatile option for secondary thoracic esophageal reconstruction.

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“…Free jejunal transfer provides an excellent reconstruction for pharyngolaryngectomy defects, with a high success rate of graft survival. [1][2][3][4][5][6][7][8] In the rare cases in which total or partial loss of the free jejunal graft occurs, despite successful microvascular anastomoses, the reasons for failure should be carefully explored. In our case 1, severe longitudinal tension at the pharyngo-jejunal anastomotic site was strongly suspected to compromise the blood supply from the mesenterium to the jejunum, according to intraoperative findings and secondary examinations.…”

Section: Discussionmentioning

confidence: 99%

“…In pharyngoesophageal reconstruction, the free jejunal transfer has been frequently utilized for restoring continuity of the alimentary tract. [1][2][3][4][5][6][7][8] It offers a reliable, fast, and safe single-stage reconstruction with acceptable morbidity, early restoration of swallowing, and low stricture rates. However, once fistula formation occurs after free jejunal transfer for pharyngoesophageal reconstruction, it produces a serious complication with potentially critical consequences.…”

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confidence: 99%

Second Free Jejunal Transfer in Complicated Pharyngoesophageal Reconstructions

Furukawa¹,

Yamamoto²,

Sasaki³

et al. 2003

J reconstr Microsurg

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The authors report two cases of pharyngoesophageal reconstruction using free jejunum transfer, which required additional microsurgical reconstruction, due to total or partial loss of the free jejunal graft, despite successful microvascular anastomoses. Replacement and additional transfer of the second free jejunum segment were successfully carried out, with minimal risk and low morbidity. The second free jejunal transfer is one of the reliable reconstructive choices in the management of complicated pharyngoesophageal reconstruction with free jejunum.

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Surgical Salvage of Failed Esophageal Reconstruction Attempted with Gastric Pedicle

Cited by 7 publications

References 1 publication

Secondary Reconstruction of Failed Esophageal Reconstruction

Secondary Reconstruction of Failed Esophageal Reconstruction

Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction

Second Free Jejunal Transfer in Complicated Pharyngoesophageal Reconstructions

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