Voice Reconstruction with Free Ileocolon Flap Transfer: Implications for the Lower Respiratory Tract

Rampazzo, Antonio; Gharb, Bahar Bassiri; Spilimbergo, Stefano Spanio di; Chung, Kuo‐Piao; Chen, Hung-Chi

doi:10.1097/prs.0b013e31820cf282

Cited by 10 publications

(17 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consensual to the decrease of the absolute number of the goblet cells, a reduction in the volume of secretions from the voice tube was noticed in all patients soon after reconstruction, reducing the chances of aspiration through the tracheostomy site and risk of pneumonia. 10 The same phenomenon, interpreted as a protective adaptive mechanism, has been reported in the urinary reservoirs reconstructed with ileum. 4,5 Four factors probably played a critical role in producing the morphological changes of the ileal and cecal mucosa, namely, deprivation from the luminal nutrients and pancreatic and biliary secretions; decrease in the growth factors acting in autocrine, paracrine, or endocrine fashion; reduced workload of nutrient absorption; and chronic intermittent exposure to the airflow.…”

Section: Discussionmentioning

confidence: 75%

Histological Changes of the Voice Tube and Possible Clinical Consequences After Voice Reconstruction With Free Ileocolon Flap

Gharb

Rampazzo²,

Hsu³

et al. 2013

Annals of Plastic Surgery

Self Cite

View full text Add to dashboard Cite

Free ileocolon flap has become a valid option for restoration of speech after pharyngolaryngectomy. After transfer, deprivation of the trophic intestinal contents and exposure to chronic intermittent airflow could substantially modify the structure of the voice tube, compromising its function. Biopsy specimens from 14 voice tube segments were examined. Sections were evaluated after staining with hematoxylin-eosin, trichromic Masson, and antiproliferating cell nuclear antigen. In all samples, the mucosa displayed diffuse atrophy and decreased proliferation rate, and in some areas only a single layer of goblet cells and enterocytes was present. Erosions, ulcerations, and dysplastic changes were absent and the alterations were limited to the mucosal layer. None of the patients experienced problems related to the modifications of the mucosa. The changes detected in the voice tube mucosa seem to indicate a physiologic adaptation to the new environment as proved by disappearance of the chronic inflammatory infiltrate and absence of erosions when the steady state was reached.

show abstract

Section: Discussionmentioning

confidence: 75%

Histological Changes of the Voice Tube and Possible Clinical Consequences After Voice Reconstruction With Free Ileocolon Flap

Gharb

Rampazzo²,

Hsu³

et al. 2013

Annals of Plastic Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Fifteen studies reported the use of postoperative chemotherapy or radiotherapy (►Table 3). 12,13,15,[17][18][19][20][24][25][26][27][28][29]33,[35][36][37][38][39] Primary and secondary reconstructions were performed in 24.6 (n ¼ 134) and in 19.1% (n ¼ 104) of the cases, respectively (►Table 4). The surgical time ranged from 8 to 14.5 hours reported in four studies.…”

Section: Resultsmentioning

confidence: 99%

“…6 Moreover, the unconstrained peristalsis and the biologic secretions supply intestinal flaps with a natural self-cleansing machinery that prevents obstruction of the reconstructed phonation tube. 6,20,26 In contrast to the ICFF, fasciocutaneous and jejunal free flaps require a trachea-esophageal prosthesis to generate voice which ultimately results in increased morbidity. In fact, the incidence of leakage around a speech prosthetic valve following TEP enlargement is acknowledged to be between 1 and 29% with a 3-fold increased risk of aspiration pneumonia, a 20 to 30% mortality rate, and 14% long-lasting requirements of nutritional support via percutaneous gastrostomy.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, a cecal plication around the terminal ileum, the application of Lembert's sutures along the longitudinal axis of the ileum, or a combined approach with a wedge excision and reinforcement with sutures of the terminal ileum have been described. 15,16,19,20 Nevertheless, optimal outcomes are usually encountered with a multimodal internal and external valve plication to attain a residual aperture of 0.5 cm, yielding a minimal incompetent valve rate of 3.33%. 20 On the other hand, with solely external plication, or external and internal plication but a residual aperture of 1 cm, incompetence of the ileocecal valve is seen in 100% of patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

et al. 2022

Self Cite

View full text Add to dashboard Cite

Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

show abstract

“…5 In the last decade, our group has conducted a significant number of aerodigestive track reconstructions using free and pedicle bowel flaps. 8,12,13,[18][19][20] Even though the success rate of these flaps is high, 6 we have noticed that when a ischemic event occurs, the portion of the bowel conduit that survives is usually the one not covered by serosa (e.g., posterior wall of the terminal ileum and ascending colon). However, and up to now, no study has demonstrated this physiological process among bowel conduits with and without serosa during ischemic events.…”

Section: Discussionmentioning

confidence: 99%

Early Markers of Angiogenesis and Ischemia during Bowel Conduit Neovascularization

Manrique

Ciudad

Wong

et al. 2017

J reconstr Microsurg

Self Cite

View full text Add to dashboard Cite

Background Bowel flaps are a good and reliable method to restore the continuity of the aerodigestive tract. Radiated fields, contaminated recipient sites, or depleted recipient vessels may increase the risk for ischemic injury after transfer. During ischemic events, we believe that bowel conduits with serosa have a delayed neovascularization process at its new recipient site.We conducted an ischemia/reperfusion murine model to understand the difference among bowel conduits with and without serosa. Materials and Methods Two groups of rats were compared: control group (jejunal conduit with serosa) and a target group (jejunal conduit without serosa). These conduits were harvested from the peritoneal cavity and transferred into a subcutaneous pocket. After 72 hours of transfer and pedicle ligation, histological changes related to ischemia/reperfusion were assessed. In addition, tissue markers of angiogenesis (CD34), ischemia (lactate dehydrogenase [LDH]), and inflammation (interleukin [IL]-1β and IL-6) were analyzed. Results Two groups (n = 20) of male rats were analyzed. Histology showed intact jejunal mucosa in the target group. The control group showed decreased number of mucin, globet cells, decreased height, and fragmentation of villi with the absence of intestinal glands. Markers of angiogenesis (CD34) were higher in the target group. In addition, markers of ischemia (LDH) (p = 0.0045) and inflammation (IL-1b, p = 0.0008, and IL-6, p = 0.0008) were significantly lower in the target group as compared with the control group. Conclusions In circumstances in which the recipient site does not offer an adequate and healthy bed or a vascular insult occurs, bowel flaps with less amount of serosa may be able to neovascularize faster thereby increasing its chances of survival.

show abstract

Voice Reconstruction with Free Ileocolon Flap Transfer: Implications for the Lower Respiratory Tract

Cited by 10 publications

References 24 publications

Histological Changes of the Voice Tube and Possible Clinical Consequences After Voice Reconstruction With Free Ileocolon Flap

Histological Changes of the Voice Tube and Possible Clinical Consequences After Voice Reconstruction With Free Ileocolon Flap

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

Early Markers of Angiogenesis and Ischemia during Bowel Conduit Neovascularization

Contact Info

Product

Resources

About