Use of the “supercharge” technique in esophageal and pharyngeal reconstruction to augment microvascular blood flow

Pancreaticoduodenectomy After Esophageal and Gastric Surgery Preserving Right Gastroepiploic Vessels

“…Some investigators regard the artery as being more important, 13,14 others consider the vein more important, 15 and yet others consider both equally important. 16 In our series, because the RGEA and RGEV were the only major pathways for arterial blood supply and venous drainage, respectively, we were concerned that their sacrifice would cause necrosis of the remnant stomach through ischemia and/or congestion, which would be critical in these cases. Therefore, we preserved both of these vessels through meticulous procedures even though it took much effort.…”

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“…However gastric conduits are not usually supercharged. As reported by Sekido and colleagues [12], the gastric graft was supercharged when a poor arterial inflow or venous drainage was noted intraoperatively. The authors concluded that both arterial and venous augmentation should be performed to improve graft outcome.…”

“…Vascular augmentation techniques to optimize arterial and venous blood flow to the graft should be considered [12,17].Therefore patients who showed intraoperative graft ischemia, adding microvessel anastomosis became necessary to salvage the graft [12,17,21]. So in comorbid patients a strategy to deal with graft ischemia this is to perform delayed graft creation, or delayed esophageal reconstruction, or supercharge of graft [17,21].…”

Extended left colon interposition for pharyngoesophageal reconstruction using distal‐end arterial enhancement

“…9 According to our review of the literature, there are reports of enhancement of the microvascular flow at the oral end of the colon interposition flap by using the supercharge procedure. [9][10][11] However, in these studies the supercharge procedure was most applied to both the artery and vein of the colon graft. This study describes five patients who underwent reconstruction of pharyngoesophageal defects with extended left colon interposition flaps through utilizing the distal arterial enhancement.…”

“…Extended left colon interposition flap in pharyngoesophageal reconstruction is associated with insufficient blood supply of the sigmoid colon toward the oral end. 10,11 The high incidence of distal ischemia necrosis of the colon graft leads to increased rate of fistula formation and hence increased mortality. Because partial graft necrosis can lead to fatal complications, maintaining reliable blood circulation in the transferred colon segment, particularly at the oral end, is extremely important for successful esophageal reconstruction.…”