Microvascular prefabricated free skin flaps for esophageal reconstruction in difficult patients
| Autor: | Chau-hsiung Chang, Hern-hsin Chen, Hung-Chi Chen, Yur-ren Kuo, Tsann-long Hwang, Yueh-Bih Tang |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Leak medicine.medical_treatment Anastomosis Surgical Flaps Postoperative Complications Swallowing Fascia Lata medicine Esophagitis Humans Esophagus Skin Esophageal disease business.industry Microcirculation Pulmonary Complication Middle Aged Microsurgery medicine.disease Surgery Forearm medicine.anatomical_structure Esophagoplasty Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 67:911-916 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/s0003-4975(99)00152-6 |
| Popis: | Background. Reconstruction of the esophagus for complicated benign stricture or after resection of malignant lesion is still a challenge for surgeons. When abdominal viscera cannot be used, skin flaps are selected for esophageal reconstruction. However, skin flaps for esophageal reconstruction are notorious for leakage, and have not been widely accepted. Prefabrication before microvascular transfer to its final site can improve the result of esophageal reconstruction when skin flaps are used. Methods. Eight patients with complicated corrosive esophagitis had been treated with prefabricated skin flaps for esophageal reconstruction. The procedures are described in detail. Results. All patients healed well without leakage. The barium study showed smooth passage. There was no dysphasia or regurgitation after education. Pulmonary complication happened in only 1 patient. Revision for the distal anastomosis was required in 1 patient due to narrowing. When the skin tube is long, the patients need water (or soup ) to facilitate swallowing and occasionally use their hand to help the food passage. This method has the following advantages: (1) healing of the long suture line before transfer to withstand the intestinal juice; (2) reliable viability in the distal part of the flap, especially when an extended length of the flap is required; (3) more length of stable tissue for two-layered, tension-free anastomosis at the junction of skin and gastrointestinal mucosa to prevent leakage; and (4) the flap can be placed in the substernal position to meet the aesthetic requirement of young patients. The disadvantage was the staged operations. However, after prefabrication the transfer becomes safe and free of leakage. The overall morbidity is minimal. Conclusions. In rare situations when skin flaps are used for esophageal reconstruction, prefabrication provides advantages over conventional one-stage methods, although it needs additional procedures. This method is a combination of conventional technique and microsurgery. |
| Databáze: | OpenAIRE |
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