Microvascular Free Transfer of Intestine



Microvascular Free Transfer of Intestine


R. S. STAHL

M. J. JURKIEWICZ



The aggressiveness of pharyngoesophageal malignancies and strictures makes unencumbered wide resection and effective palliation essential goals in their treatment. It is applications such as these for which microvascular free transfers of intestine are well suited (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16).




FLAP DESIGN AND DIMENSIONS

While approximation of resection margins is usually possible in the hypopharynx and upper esophagus, excessive tension all too often results in stricture, fistula, or limitation of tongue mobility. Local mucosal flaps are often satisfactory for small or less than circumferential defects. Regional unipedicled cervical flaps (17) provide a logical, regional, albeit multistage, means of reconstruction. The Wookey flap (18) is also limited by the extent of previous neck dissection and radiation and requires the presence of a pharyngostome and an esophagostome.

The medially based deltopectoral flaps (19) employ tissue with a known arterial supply from beyond irradiated or dissected cervical tissue to restore upper aerodigestive continuity. This procedure also requires the interim use of stomata and typically requires two or more stages. Reversed split-thickness skin grafts supported by tantalum or steel mesh (20, 21) have been used, but they frequently result in stricture formation or mesh migration and erosion.

In the fortuitous event that the anterior upper half of the trachea and larynx is spared from tumor, this tissue may be used to reconstitute the anterior esophageal wall (22, 23). It has been noted that split-thickness skin grafts may be used for recreation of the posterior pharyngeal wall if necessary. While providing a conservative means of reconstructing the hypopharynx in a single-stage procedure, this technique is limited by the restrictions it places on margins of resection, as well as postoperative stricture formation.

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Microvascular Free Transfer of Intestine
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