1
|
Amendola F, Spadoni D, Lundy JB, Cottone G, Velazquez-Mujica J, Platsas L, Chen HC. Reducing complications in reconstruction of the cervical esophagus with anterolateral thigh flap: The five points protocol. J Plast Reconstr Aesthet Surg 2022; 75:3340-3345. [PMID: 35614011 DOI: 10.1016/j.bjps.2022.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Patients suffering from hypopharyngeal cancer commonly present in the advanced stage and undergo a circumferential pharyngolaryngectomy. The possibility to reconstruct the esophagus and achieve an oral alimentation can significantly reduce the additional burden of a jejunostomy. The cervical esophagus is usually reconstructed with jejunal free flap (JFF) or fasciocutaneous free flap such as the anterolateral thigh (ALT) free flap. The latter has proved its donor-site safety and fast recovery. However, it is burdened by a high fistula rate. We present our five points protocol for reducing fistula rate and improving outcome. Twenty-eight patients underwent total pharyngolaryngectomy and required esophageal reconstruction with ALT flap from 2015 to 2020. In each patient, we performed five adjustments: a thicker dermal layer, a two-layer closure, a barrier from the tracheostomy, a nonabsorbable monofilament suture, and two NG tubes to enhance neoesophageal drainage. Twenty-five (89%) patients returned to solid or soft food diet after the reconstruction. Three patients had liquid diet. Contrast media leakage was observed in only 2 (7%) patients during esophagography at three weeks, with only one needing surgical revision. Our five points protocol for ALT reconstruction of cervical esophagus proved to be effective in achieving an incredibly low rate of complications, without the burden of significant donor-site complications.
Collapse
Affiliation(s)
- Francesco Amendola
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, Milan 20161, Italy
| | - Davide Spadoni
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, No. 91, Xueshi Road, North District, Taichung City 404, Taiwan
| | - Jonathan B Lundy
- US Army Institute of Surgical Research, 3698 Chambers Road, Fort Sam Houston 78234, TX, USA
| | - Giuseppe Cottone
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, Milan 20161, Italy
| | - Jonathan Velazquez-Mujica
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, No. 91, Xueshi Road, North District, Taichung City 404, Taiwan
| | - Loukas Platsas
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, No. 91, Xueshi Road, North District, Taichung City 404, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, No. 91, Xueshi Road, North District, Taichung City 404, Taiwan.
| |
Collapse
|
2
|
Woods JFC, Woods RSR, Lennon P, Timon C, Kinsella J, Ravi N, Beausang E, Theopold CFP. Analysis of Outcomes of Pharyngo-laryngo-esophagectomy and Reconstruction with Longitudinal Comparison in a Single Institution. J Plast Reconstr Aesthet Surg 2021; 75:1567-1572. [PMID: 34955400 DOI: 10.1016/j.bjps.2021.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/14/2021] [Indexed: 11/25/2022]
Abstract
Advanced hypopharyngeal tumours present complex clinical challenges, and where resection is attempted, there is a requirement for major reconstruction. Despite advances in surgical technique, outcomes remain poor for this patient group, and optimum treatment has yet to be established. We aimed to assess the treatment and outcomes of patients in our institution in the context of previous studies. All patients from 2008 to 2018 who underwent surgical management for hypopharyngeal tumours with pharyngo-laryngo-esophagectomy and flap-based reconstruction were included in the study. Demographic and outcome data were collected, and patient-reported outcomes were solicited from surviving patients using the EORTC QLQ H&N 43 questionnaire. Thirty patients were assessed, in which 12 had gastric pull-ups, 16 had free jejunum flaps, and 2 had free anterolateral thigh flaps. There was a 38% five-year survival rate. Overall, the rates of stricture (10.7%) and fistula (7.1%) were low. The majority of patients (53.6%) returned to a normal diet within three months with a soft or puree diet in 35.7% of patients. Some form of speech was possible in 92.9% of patients. The average questionnaire score for surviving patients was 87.3, with good outcomes related to eating and swallowing, but poorer outcomes for speech and communication. This study showed that outcomes for patients receiving complex reconstruction following hypopharyngeal tumour resection are improving over time. There is still scope for improvement of patient outcomes and refinement of optimum surgical management strategies.
Collapse
Affiliation(s)
- Jack F C Woods
- Department of Surgery, St James's Hospital, Dublin, Ireland.
| | | | - Paul Lennon
- Department of Surgery, St James's Hospital, Dublin, Ireland
| | - Conrad Timon
- Department of Surgery, St James's Hospital, Dublin, Ireland
| | - John Kinsella
- Department of Surgery, St James's Hospital, Dublin, Ireland
| | | | - Eamon Beausang
- Department of Surgery, St James's Hospital, Dublin, Ireland
| | | |
Collapse
|
3
|
Walia A, Lee JJ, Jackson RS, Hardi AC, Bollig CA, Graboyes EM, Zenga J, Puram SV, Pipkorn P. Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2021; 167:224-235. [PMID: 34491852 PMCID: PMC8972962 DOI: 10.1177/01945998211044683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management. DATA SOURCES Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019. REVIEW METHODS Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications. RESULTS A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies, I2 = 12.8%). There was no difference in hospitalization length after secondary reconstruction between free tissue transfer and locoregional flaps or conservative management (relative risk of hospitalization ≥2 weeks, 96%; 95% CI, 0.80-1.14; n = 3 studies, I2 = 0). The pooled relative risk of perioperative complications following free tissue transfer was 0.60 when compared with locoregional flap or conservative management (95% CI, 0.40-0.92; n = 5 studies, I2 = 0). CONCLUSION Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.
Collapse
Affiliation(s)
- Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Jake J Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Angela C Hardi
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Craig A Bollig
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| |
Collapse
|
4
|
Jejunal and ileocolic free flaps for digestive tract reconstruction following pharyngo-laryngo-oesophagectomy - 30 years of single-centre experience. Contemp Oncol (Pozn) 2021; 25:28-32. [PMID: 33911979 PMCID: PMC8063902 DOI: 10.5114/wo.2021.105074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Hypopharyngeal cancer accounts for 3–5% of all squamous-cell carcinoma (SCC) of the head and neck and has one of the worst prognoses. The aim of the study was to evaluate oncologic and functional treatment outcomes in patients with T3-T4a squamous cell hypopharyngeal and laryngeal cancer. Material and methods Retrospective analysis of the material from one treatment site included 90 patients (81 male, 9 female) who had undergone surgery between 1986 and 2010. Their mean age was 55.06 years (range 36–75). Results TNM (T – tumour, N – node, M – metastasis) staging assessment was feasible in 70 treatment-naïve patients (77.78%): 57 (63.33%) were classified to stage T4a, and 13 were classified to T3 (14.44%). Cervical lymphadenopathy was observed in 53 (63.3%) patients; in 44 patients (48.89%) postoperative histopathology confirmed metastatic disease. G2 or G3 SCC was detected in 80% of patients. All patients underwent laryngopharyngoesophagectomy (LPE). Digestive tract reconstruction was performed using one of two methods: jejunal autograft (JA) in 79 patients (87.78 %) – Group A or ileocolic autograft (IA) in 11 patients (12.22%) – Group B. Comparative statistical analysis of both groups showed statistically significant differences only for substitute speech production. The mean survival time of patients from both groups was 2.21 years after reconstruction surgery. Conclusions JA or IA for digestive tract reconstruction in patients after LPE are burdened with high risk of complications but offer patients the chance of a normal oral diet shortly after surgery. Ileocolic autograft enables rapid production of substitute speech.
Collapse
|
5
|
Bouhadana G, Azzi AJ, Gilardino MS. The ideal flap for reconstruction of circumferential pharyngeal defects: A systematic review and meta-analysis of surgical outcomes. J Plast Reconstr Aesthet Surg 2021; 74:1779-1790. [PMID: 33931325 DOI: 10.1016/j.bjps.2021.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/10/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a lack of consensus regarding the superiority of the common free flaps for the reconstruction of circumferential pharyngeal defects. METHODS A systematic literature search was conducted to identify studies reporting the complications of circumferential pharyngeal reconstruction between 2005 and 2020. Anterolateral thigh free flaps (ALTFF), jejunal free flaps (JFF), and radial forearm free flaps (RFFF) were compared. Various complications were compared by meta-analysis. Primary endpoints were fistula and stricture rates. RESULTS Forty studies were included (2230 patients). Stricture rate was similarly low with tubed ALTFF (13.3%, n = 36/270) and JFF (13.2%, n = 176/1334). Fistula rate was the lowest with JFF (9.2%, n = 58/634). ALTFF was associated with the lowest rates of partial and complete flap failure (3.8%, n = 6/157, and 2.8%, n = 5/178), infection (2.8%, n = 3/106), donor site morbidity (3.9%, n = 5/130), and mortality (0%, n = 0/101) within 30 days. A meta-analysis demonstrated that there was no statistically significant difference in stricture and fistula rates between ALTFF and JFF. Moreover, JFF was associated with a significantly lower fistula rate than that of RFFF (p < 0.001). ALTFF was associated with a significantly lower infection rate than that of JFF (p = 0.013). CONCLUSIONS The data suggest the use of ALTFF for circumferential pharyngeal defects. In the absence of randomized, prospective data, the authors hope the results presented can be used as an evidence-based reference.
Collapse
Affiliation(s)
| | - Alain J Azzi
- Division of Plastic and Reconstructive Surgery, McGill University, 1650 Cedar Avenue, Montreal H3G 1A4, Quebec, Canada.
| | - Mirko S Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University, 1650 Cedar Avenue, Montreal H3G 1A4, Quebec, Canada
| |
Collapse
|
6
|
Chow VLY, Chan JYW, Cheng IKY, Chan KMK. Swallowing disorders following free jejunal flap reconstruction of circumferential pharyngeal defect: Does Botox help? Oral Oncol 2020; 104:104612. [PMID: 32135435 DOI: 10.1016/j.oraloncology.2020.104612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/13/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Free jejunal flap for circumferential pharyngeal reconstruction is associated with late-onset dysphagia, regurgitation and prolonged transit time. This study aims to assess the feasibility and efficacy of Botulinum toxin A (Botox) in alleviating such swallowing dysfunction. MATERIALS AND METHODS Twenty-six consecutive patients underwent free jejunal flap for circumferential pharyngeal reconstruction between January 2012 and December 2018. Outcomes were compared at 6, 12 and 24 months. RESULTS In the non-Botox group (n = 13), video-fluoroscopic and manometry studies demonstrated asynchronous contractions and retrograde propulsion. All patients complained of nasal regurgitation on thin fluids at 6, 12 and 24 months. Bolus residue accumulation along jejunal mucosal folds resulted in prolonged transit time. In the Botox group (n = 13), amplitude of asynchronous contractions were lower: 25.4 mmHg vs. 52.1 mmHg (p = 0.037) for thin fluids at 12 months. Three patients complained of nasal regurgitation on thin fluids at 6 months. All 3 were asymptomatic at 12 months. Transit time was shortened overall. Functional Oral Intake Scale was higher. MD Anderson Dysphagia Inventory global (72.5% vs 45.7%, p = 0.003) and functional (62.0% vs 40.6%, p = 0.012) subscales were significantly improved at 24 months. CONCLUSION Botox safely and effectively alleviates swallowing dysfunction associated with free jejunal flap for circumferential pharyngeal reconstruction.
Collapse
Affiliation(s)
- Velda L Y Chow
- Division of Head and Neck Surgery and Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
| | - Jimmy Y W Chan
- Division of Head and Neck Surgery and Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ivy K Y Cheng
- Division of Speech and Hearing Sciences, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Karen M K Chan
- Division of Speech and Hearing Sciences, Faculty of Education, The University of Hong Kong, Hong Kong
| |
Collapse
|
7
|
Kubo T, Kurita T, Tashima H, Seike S, Fujii T, Yano M, Yamasaki M, Doki Y, Hosokawa K. Free jejunal flap transfer containing multiple vascular pedicles for pharyngoesophageal reconstruction in conjunction with anterior mediastinal tracheostomy. Microsurgery 2018; 38:852-859. [PMID: 30152100 DOI: 10.1002/micr.30359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/07/2018] [Accepted: 06/20/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND When pharyngoesophagectomy is performed in conjunction with anterior mediastinal tracheostomy, reconstructing both the trachea and alimentary tract is extremely difficult. We developed a novel 1-stage reconstructive procedure using a single free jejunal flap containing multiple vascular pedicles to decrease postoperative morbidity and mortality. Free jejunal flap transfer with multiple vascular pedicles could offer a viable option for reducing associated life-threatening complications. METHODS We performed a retrospective review of 34 patients who underwent free jejunal flap transfer with multiple vascular pedicles in anterior mediastinal tracheostomy and pharyngoesophagectomy due to lesions involving both the airway and esophagus. In all cases, 1-stage reconstruction of the digestive tract and trachea was performed. Technical details and outcomes were analyzed. RESULTS All 34 jejunal flaps (100%) survived. Major morbidity classified as Clavien-Dindo grades III and IV occurred in 10 (29.4%) and 0 (0%) patients, respectively during hospitalization. With regard to common complications, anastomotic leakage from transferred jejunal flaps and surgical site infections occurred in 0 (0%) and 7 (20.6%) patients, respectively. Five (14.7%) patients experienced tracheal stoma dehiscence. Donor site morbidity was observed in 2 (5.9%) patients. The overall in-hospital mortality rate was 2.9%. CONCLUSIONS Our 1-stage reconstruction procedure achieved low morbidity and low mortality rates following anterior mediastinal tracheostomy and pharyngoesophagectomy. Only 1 jejunal flap transfer is needed to simultaneously reconstruct the trachea and alimentary tract in a safe and reliable manner with this procedure.
Collapse
Affiliation(s)
- Tateki Kubo
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoyuki Kurita
- Department of Plastic and Reconstructive Surgery, Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroki Tashima
- Department of Plastic and Reconstructive Surgery, Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Osaka, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Yano
- Department of Gastroenterological Surgery, Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ko Hosokawa
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
8
|
Kurita T, Kubo T, Tashima H, Fujii T. Free jejunal flap transfer with multiple vascular pedicles for safe and reliable pharyngoesophageal reconstruction. Head Neck 2018; 40:2210-2218. [DOI: 10.1002/hed.25313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/15/2018] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Tomoyuki Kurita
- Department of Plastic and Reconstructive Surgery, Osaka Prefectural Hospital Organization; Osaka International Cancer Institute; Osaka Japan
| | - Tateki Kubo
- Department of Plastic Surgery; Osaka University Graduate School of Medicine; Osaka Japan
| | - Hiroki Tashima
- Department of Plastic and Reconstructive Surgery, Osaka Prefectural Hospital Organization; Osaka International Cancer Institute; Osaka Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka Prefectural Hospital Organization; Osaka International Cancer Institute; Osaka Japan
| |
Collapse
|
9
|
Tachibana S, Miyamoto S, Goto T, Ishida K, Iida T, Okazaki M, Yoshida S, Nomura S, Hayashi R, Sakuraba M. Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1599. [PMID: 29632778 PMCID: PMC5889443 DOI: 10.1097/gox.0000000000001599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/20/2017] [Indexed: 12/02/2022]
Abstract
Background: Free jejunal transfer (FJT) is a standard method of reconstruction after total pharyngo-laryngo-cervical esophagectomy (TPLE) in patients with advanced head and neck cancer. However, it is related to various degrees of postoperative swallowing dysfunction. This study aimed to assess whether the tensed and straight FJT method results in a reduced rate of postoperative dysphagia compared with historical controls. Methods: Patients who were undergoing FJT after TPLE for squamous cell carcinoma of the hypopharynx or cervical esophagus were enrolled. The primary endpoint was the rate of not developing dysphagia within 6 months of the surgery, and we compared this value with that obtained from historical data of patients who underwent FJT. The secondary endpoint was the rate of developing surgical complications. Results: Although 128 patients were registered between August 2012 and July 2015, 7 were excluded based on the exclusion criteria. Of the remaining 121 patients, FJT with the craniocaudally tensed and straight method was performed in all patients. The rate of not developing dysphagia and its 95% confidence interval (CI) were 66.1% and 57.0–74.5%, respectively. The lower limit of the CI was higher than the prespecified threshold value of 50.0%. The rate of developing complications of total necrosis of the jejunum was 3.3%, cervical infection was 9.9%, and major anastomotic leakage was 4.1%. Conclusions: Our findings revealed that the proportion of postoperative dysphagia decreased in patients who underwent tensed and straight FJT. This method may become the standard surgical method in reconstruction of defects after TPLE.
Collapse
Affiliation(s)
- Satsuki Tachibana
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Shimpei Miyamoto
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Takahiro Goto
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Katsuhiro Ishida
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Sei Yoshida
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Shogo Nomura
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Ryuichi Hayashi
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| | - Minoru Sakuraba
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan
| |
Collapse
|
10
|
Ni S, Zhu Y, Qu D, Wang J, Li D, Zhang B, Xu Z, Liu S. Morbidity and Functional Outcomes following Free Jejunal Flap Reconstruction for Head and Neck Cancer. ORL J Otorhinolaryngol Relat Spec 2017; 79:212-221. [DOI: 10.1159/000477969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/31/2017] [Indexed: 12/14/2022]
|
11
|
Piazza C, Bon FD, Paderno A, Grammatica A, Montalto N, Taglietti V, Nicolai P. Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects. Laryngoscope 2017; 127:2731-2737. [PMID: 28573675 DOI: 10.1002/lary.26705] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/06/2017] [Accepted: 04/27/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES/HYPOTHESIS Different reconstructive options are available for defects following total laryngectomy (TL) and circumferential (CH) or partial hypopharyngectomy (PH). We evaluated the flap success, pharyngocutaneous fistula, and pharyngoesophageal stenosis rates in two groups of patients treated by different policies. STUDY DESIGN Comparison between two cohorts of patients treated by TL with PH/CH ± cervical esophagectomy and reconstructed according to different strategies. METHODS Group A (historical) was composed of 89 patients reconstructed by pectoralis major myocutaneous (PMMC), radial forearm (RF), and anterolateral thigh (ALT) flaps. A salivary bypass stent (SBPS) was not routinely applied and left in place for a maximum of 14 days. Forty-four (49%) patients received preoperative radiotherapy/chemoradiotherapy (RT/CRT). Group B (prospective) included 105 patients reconstructed by RF or ALT with long-lasting SBPS left in place for a maximum of 45 days. Sixty-one (59%) received preoperative RT/CRT. RESULTS In group A, flap failure occurred in four (4%) cases, and all were managed by PMMC. We encountered 22 (26%) fistulas and 14 (16%) stenoses. In group B, flap failure occurred in six (6%) cases and was managed by PMMC. We encountered seven (7%) fistulas and three (3%) stenoses. Comparing complications among the two groups, we encountered a statistically significant difference in favor of group B for both fistula (P < .001) and stenosis (P = .001). We did not evidence any significant difference in terms of flap success rate. CONCLUSIONS First-line application of RF and ALT free flaps with long-lasting SBPS in reconstruction after PH/CH allows obtaining reduced incidences of both fistula and stenosis. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2731-2737, 2017.
Collapse
Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Nausica Montalto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Valentina Taglietti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| |
Collapse
|
12
|
Ki SH, Choi JH, Sim SH. Reconstructive Trends in Post-Ablation Patients with Esophagus and Hypopharynx Defect. Arch Craniofac Surg 2015; 16:105-113. [PMID: 28913234 PMCID: PMC5556778 DOI: 10.7181/acfs.2015.16.3.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 12/18/2022] Open
Abstract
The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.
Collapse
Affiliation(s)
- Sae Hwi Ki
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea.,Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Jong Hwan Choi
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | | |
Collapse
|
13
|
Ni S, Zhu Y, Wang J, Li D, Zhang B, Xu Z, Liu S. Salvage Procedures after Total Necrosis of a Free Jejunal Graft. ORL J Otorhinolaryngol Relat Spec 2015; 77:262-7. [PMID: 26315969 DOI: 10.1159/000433548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 05/22/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE OF THE STUDY To determine the appropriate salvage method after total necrosis of a jejunal graft after reconstruction of total laryngopharyngoesophagectomy or a larynx-preserving operation, considering the complexity of medical service in China. PROCEDURES We reviewed 5 patients with a mean age of 61 years who developed total jejunal graft necrosis and underwent reconstruction of a free jejunal transfer in our hospital. The total number and choice of salvage procedures, the symptoms and the results of salvage for the 5 patients have been reviewed. RESULTS Four of the 5 patients survived. One of them underwent gastric pull-up reconstruction and recovered well. One patient died due to severe infection after the loss of the jejunal graft and secondary gastric pull-up reconstruction. A temporary external fistula was formed in 3 patients after the initial jejunal graft necrosis, 2 of which underwent fistula repair 6 and 5 months later, while one went on long-term gastric tube feeding. CONCLUSION Our results suggest that a temporary external fistula formation is an optional secondary salvage procedure after total necrosis of an initial jejunal graft, considering the relatively low quality of medical service in China.
Collapse
Affiliation(s)
- Song Ni
- Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
14
|
Walker RJ, Parmar S, Praveen P, Martin T, Pracy P, Jennings C, Simms M. Jejunal free flap for reconstruction of pharyngeal defects in patients with head and neck cancer—the Birmingham experience. Br J Oral Maxillofac Surg 2014; 52:106-10. [DOI: 10.1016/j.bjoms.2013.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
|
15
|
Dolan RT, Butler JS, Murphy SM, Hynes D, Cronin KJ. Health-related quality of life and functional outcomes following nerve transfers for traumatic upper brachial plexus injuries. J Hand Surg Eur Vol 2012; 37:642-51. [PMID: 22178751 DOI: 10.1177/1753193411432706] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the patient-scored Health-Related Quality of Life (HRQoL) and functional outcomes of a cohort of 21 consecutive patients undergoing nerve transfer surgery for traumatic upper brachial plexus injuries. Outcomes were assessed using the British Medical Research Council power grading system, Short-Form 36, Disability of Arm, Shoulder and Hand questionnaire, and Pain Visual Analogue Scale (PVAS). The mean age of our cohort was 29.8 years (range 18-53 years), with a mean follow-up period of 42.9 months. At follow-up, elbow flexion ≥ M3 strength was achieved in 17/21 patients. Shoulder abduction ≥ M3 was achieved in 14/19 patients. External rotation ≥ M3 strength was achieved in 11/15 patients. Delayed surgical repair correlated negatively with HRQoL outcomes. Higher injury severity scores and smoking were associated with higher PVAS scores. These findings provide key prognostic information for patients and peripheral nerve surgeons embarking upon this intensive pathway to potential recovery.
Collapse
Affiliation(s)
- R T Dolan
- Department of Plastic & Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | | | | | | |
Collapse
|
16
|
Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg 2012; 20:77-88. [PMID: 22327791 DOI: 10.1097/moo.0b013e328350a5cc] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The present review is focused on the main reconstructive options currently used after partial or circumferential resection of the hypopharynx and cervical esophagus. The advantages and disadvantages of pectoralis major myocutaneous (PMMC) pedicled flap, fasciocutaneous free flaps as radial forearm and anterolateral thigh (ALT), and visceral free grafts like jejunum and gastro-omental are overviewed. RECENT FINDINGS For partial hypopharyngeal defects with limited extension to the cervical esophagus, no specific pedicled or free flap is deemed superior over others: the patient's body habitus and surgeon's preference remain the most important factors affecting the reconstructive choice. In contrast, after circumferential hypopharyngectomy, pharyngocutaneous fistula (PCF) and stricture rates of PMMC are higher than those obtained by free flaps. In the most recent series applying ALT and jejunum, PCF and stricture occurrence is comparable, whereas reduced mortality, overall complication rate, and donor-site morbidity of ALT and its better swallowing and speech outcomes have contributed to make this option progressively more popular. On the other hand, gastro-omental seems to offer an unparalleled amount of highly vascularized tissue to manage the difficult situation of salvage surgery after chemoradiation, even though complication rates remain not negligible and this technique has not been widely adopted. SUMMARY The reconstructive armamentarium of head and neck surgeons involved in hypopharyngeal and cervical esophagus reconstruction should encompass every option described herein in order to appropriately deal with specific clinical needs and patient requirements. However, fasciocutaneous free flaps (especially ALT) seem to play an ever greater role in restoration of pharyngoesophageal continuity.
Collapse
|
17
|
Dolan RT, Butler JS, Murphy SM, Cronin KJ. Health-related quality of life, surgical and aesthetic outcomes following microvascular free flap reconstructions: an 8-year institutional review. Ann R Coll Surg Engl 2012; 94:43-51. [PMID: 22524928 PMCID: PMC3954186 DOI: 10.1308/003588412x13171221498749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 09/23/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Microvascular free flap reconstruction has revolutionised the reconstruction of complex defects of traumatic, oncological, congenital and infectious aetiologies. Complications of microvascular free flap procedures impact negatively on patient post-operative course and outcome. METHODS We performed a retrospective analysis of 102 consecutive patients undergoing 108 free flap procedures at a tertiary referral centre over an 8-year period. Logistic regression analysis was used to identify factors predictive of free flap complications. Health-related quality of life (HRQoL) and aesthetic outcomes were assessed using the Short Form 36 questionnaire and a satisfaction visual analogue scale respectively. RESULTS In total, 108 free tissue transfers were performed; 23% were fasciocutaneous free flaps, 69% musculocutaneous and 8% osteoseptocutaneous. The overall flap success rate was 92.6%. Over a third of patients (34.3%) had flap-related complications ranging from minor wound dehiscence to total flap loss. ASA (American Society of Anesthesiologists) grade ≥2 (OR: 16.9, 95% CI: 15.3-18.1, p<0.009), history of smoking (OR: 6.1, 95% CI: 5.5-7.2, p<0.049), body mass index ≥25 kg/m(2) (OR: 21.3, 95% CI: 20.8-22.1, p<0.003), low albumin (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.2-3.9, p<0.003) and peripheral vascular disease (OR: 6.9, 95% CI: 5.9-7.5, p<0.036) were identified as factors independently predictive of free flap complications. CONCLUSIONS Patients undergoing uncomplicated free flap surgery and those reporting superior post-operative flap aesthesis have higher HRQoL scores. Microvascular free tissue transfer has revolutionised our approach to the reconstruction of complex defects, providing a safe, reliable procedure to restore functionality and quality of life for patients.
Collapse
Affiliation(s)
- R T Dolan
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | | | | |
Collapse
|
18
|
Guo W, Wang RW, Jiang YG, Zhao YP, Zhou JH, Gong TQ. Reconstruction of hypopharyngeal and cervical esophageal defect after resection of hypopharyngeal carcinoma: a new technique based on the use of bilateral platysma myocutaneous flaps. Dis Esophagus 2011; 24:404-10. [PMID: 21309912 DOI: 10.1111/j.1442-2050.2010.01162.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Commonly used procedures for reconstructing hypopharyngeal and cervical esophageal defects resulting from total laryngopharyngectomy (TL) are the gastric conduit or colon transposition as well as microvascularized free flaps. Herein we designed an alternative procedure utilizing bilateral platysma myocutaneous flaps (PMCFs) for the reconstruction of hypopharyngeal and cervical esophageal defects. This report summarizes the technical description of this procedure. TL and cervical esophagectomy were performed and bilateral PMCFs were harvested for reconstruction of hypopharyngeal and cervical esophageal defects in 25 patients aged between 46 and 73 years (mean 58.7 ± 16.2 years). All these patients had advanced-stage (IV) cancer with involvement of the cervical esophagus. Operative time ranged from 176 to 382 minutes (average 243 ± 91 minutes) and the mean intraoperative blood loss was 294 ± 119mL. There were six cases of anastomotic leak (24.0%) and two of them (8.0%) developed anastomotic stricture. Neither flap necrosis nor postoperative death was observed. The majority of our patients (68.0%) were restored to a normal unrestricted oral diet after surgery. The 3-year and 5-year actuarial survival rates were approximately 54.7% and 26.1%, respectively. We conclude that reconstruction of the cervical esophagus with bilateral PMCFs is a valuable method for treating advanced hypopharyngeal carcinoma.
Collapse
Affiliation(s)
- W Guo
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | | | | | | | | | | |
Collapse
|
19
|
Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis. Plast Reconstr Surg 2011; 127:173-180. [PMID: 21200211 DOI: 10.1097/prs.0b013e3181f95a36] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Esophageal reconstruction after total esophagectomy remains a formidable task irrespective of the conduit chosen. Historically, the gastric pull-up and colonic interposition have served as primary choices for such defects. However, where the stomach and colon are unavailable or unsuitable, the jejunum serves as a reliable alternative for the reconstruction of total esophageal defects. METHODS The authors performed an outcomes analysis of a single surgeon's surgical technique and experience. Patients who received supercharged pedicled jejunum flaps for reconstruction of total esophageal defects over a 3-year period were included in this study. Data were collected prospectively evaluating operative technique, length of hospital stay, operative time, complications, postoperative diet, and quality-of-life outcomes analysis. RESULTS Five patients underwent supercharged pedicled jejunal flap surgery during this study period. All flaps had complete viability and no microvascular complications. One patient had a radiographic anastomotic leak detected by barium swallow that was reexplored and closed primarily and reinforced with a pectoralis advancement flap with subsequent resolution. All patients are currently tolerating a regular diet and there are no symptoms of reflux or dumping. No conduit strictures or redundancy has been found to date, and there has been no need for reoperation in the long term. CONCLUSIONS The supercharged jejunum flap is a reliable alternative to the gastric pull-up and colonic interposition for total esophageal reconstruction. In our experience, the key maneuver in this technique is a substernal tunnel for the jejunal conduit and exposure of recipient vessels and the esophageal stump by means of a manubriectomy, clavicle resection, partial first rib resection and, occasionally, a second rib resection.
Collapse
|
20
|
Song M, Chen SW, Zhang Q, Yang AK, Zhuang SM, Wang LP, Chen WK, Guo ZM. External monitoring of buried radial forearm free flaps in hypopharyngeal reconstruction. Acta Otolaryngol 2011; 131:204-9. [PMID: 21034173 DOI: 10.3109/00016489.2010.518157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The radial forearm free flap (RFFF) is one of the optimal choices for hypopharyngeal reconstruction. Our series demonstrates that the technique of an indicator flap for the monitoring of the buried flap is simple, reliable, and inexpensive. The condition of the indicator flap can be easily interpreted by the physicians and the nursing staff. Therefore, the success rate of this microsurgical reconstruction may be improved. OBJECTIVES The RFFF is increasingly applied in reconstruction of the hypopharynx after radical resection for advanced hypopharyngeal cancer. However, postoperative monitoring of the buried free flap is extremely difficult. We designed a small external component as an indicator flap to monitor the perfusion of the buried vascular pedicle. METHODS Eight consecutive patients with hypopharyngeal cancer underwent radical surgery and hypopharyngeal reconstruction using RFFF at the Sun Yat-sen University Cancer Center between January 2005 and January 2007. The indicator flap was sutured to the surface of the neck for postoperative monitoring. RESULTS All of the indicator flaps remained viable. One patient experienced vascular compromise and was successfully salvaged. The success rate of the buried flaps was 100%. Pharyngocutaneous fistula occurred in one patient. All patients resumed an oral diet eventually.
Collapse
Affiliation(s)
- Ming Song
- Department of Head and Neck Surgery and State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Keereweer S, Sewnaik A, Kerrebijn J, Meeuwis C, Tilanus H, de Wilt J. Salvage or what follows the failure of a free jejunum transfer for reconstruction of the hypopharynx? J Plast Reconstr Aesthet Surg 2010; 63:976-80. [DOI: 10.1016/j.bjps.2009.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 02/10/2009] [Accepted: 03/15/2009] [Indexed: 10/20/2022]
|
22
|
Sharp DA, Theile DR, Cook R, Coman WB. Long-term Functional Speech and Swallowing Outcomes Following Pharyngolaryngectomy With Free Jejunal Flap Reconstruction. Ann Plast Surg 2010; 64:743-6. [DOI: 10.1097/sap.0b013e3181af3019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Early and long-term morbidity after total laryngopharyngectomy. Eur Arch Otorhinolaryngol 2010; 267:1437-44. [PMID: 20372916 PMCID: PMC2908431 DOI: 10.1007/s00405-010-1244-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 03/26/2010] [Indexed: 11/12/2022]
Abstract
To determine the early and long-term morbidity of patients treated with a total laryngopharyngectomy and reconstruction using a jejunum interposition or gastric pull-up procedure. It is a retrospective study; and it is conducted in tertiairy referral center. Sixty-three patients were included in whom 70 reconstructions were performed (51 jejunum interpositions and 19 gastric pull-up procedures) between 1990 and 2007. The studied parameters were success rate of the reconstruction, early and long-term complication rate, and functional outcome including quality of life. Subjective quality of life analysis was determined by two questionnaires: the EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, and the EORTC-Head and Neck (H & N 35). The success rates were 84 and 74%, respectively. The procedures were associated with a high complication rate (63% after jejunum interposition and 89% after gastric pull-up), and a lengthy rehabilitation. Surviving patients were found to have a good long-term quality of life. Complete oral intake was achieved in 97%, and speech rehabilitation in 95%. These procedures are associated with significant morbidity, high complication rates, lengthy rehabilitation, but a good long-term quality of life.
Collapse
|
24
|
Keereweer S, Sewnaik A, Kerrebijn JDF, Meeuwis CA, Tilanus HW, De Wilt JHW. Dysphagia after an L-shaped reconstruction technique of the free jejunum graft. J Plast Reconstr Aesthet Surg 2009; 63:1820-4. [PMID: 19969514 DOI: 10.1016/j.bjps.2009.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/01/2009] [Accepted: 11/06/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The free jejunum graft is a well-established reconstruction technique after total laryngopharyngectomy. However, besides necrosis of the jejunum graft, the two most important complications are pharyngocutaneous fistula formation and dysphagia due to stricture formation. OBJECTIVES This study aims to develop an L-shaped reconstruction technique of the free jejunum graft to decrease pharyngocutaneous fistula formation and long-term stricture formation after total laryngopharyngectomy. METHODS An L-shaped side-to-end anastomosis was performed at the proximal end of the jejunum graft in six patients treated for piriform sinus carcinoma. Patient and operation characteristics and follow-up were recorded. RESULTS A successful jejunum transfer was performed in all six patients. No pharyngocutaneous fistula or stricture formation occurred during a median follow-up of 23 months (range: 18-30 months). Swallowing rehabilitation started at the median 12th postoperative day (range: 5-150 days). Four patients developed dysphagia at a median of 2 months (range: 1-6 months) after oral intake was started. X-barium swallow revealed a redundant pouch of the transferred jejunum graft, which resulted in compression on the jejunum interposition during swallowing. In three patients, an operation was required to resolve these problems. After the revision operation, no dysphagia occurred during a median follow-up of 12 months (range: 7-13 months). CONCLUSIONS Because of dysphagia complaints in the majority of our patients, we cannot recommend the described technique and should find other means to improve direct postoperative results and long-term quality of life in this difficult-to-treat group of patients.
Collapse
Affiliation(s)
- S Keereweer
- Department of Head and Neck surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
25
|
Functional Outcomes and Reevaluation of Esophageal Speech After Free Jejunal Transfer in Two Hundred Thirty-Six Cases. Ann Plast Surg 2009; 62:54-8. [DOI: 10.1097/sap.0b013e31817439c5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|