Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration Journal Article

  

Authors:	McCarthy, C. M.; Kraus, D. H.; Cordeiro, P. G.
Article Title:	Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration
Abstract:	Background: Combined defects of the skin, larynx, pharynx, and esophagus after central compartment exenteration of the neck can be extremely difficult to reconstruct. The objective of this article is to evaluate reconstruction of the central compartment using a combination of free jejunal transfer for pharyngoesophageal reconstruction, together with regional deltopectoral flaps for tracheostomal reconstruction and cutaneous resurfacing. Myocutaneous flaps, such as pectoralis major and latissimus dorsi flaps, have been used previously for external coverage but can be bulky, causing obstruction of the tracheostoma. Methods: From 1995 to 2002, seven patients underwent reconstruction of the central compartment with seven jejunal and nine deltopectoral flaps. Five patients required resection for tracheostomal recurrence of squamous cell carcinoma, and two patients required resection for massive pharyngocutaneous fistulas. Flap survival, complications, and outcomes were evaluated retrospectively. Results: The mean age of the patients was 68.7 years and the mean length of follow-up was 1.9 years. Overall free jejunal and deltopectoral flap survival was 100 percent, with no partial loss. All patients maintained an adequate airway with stomal patency. Conclusions: These complicated defects can be effectively repaired with free jejunal transfers to restore continuity of the alimentary tract and deltopectoral flaps to reconstruct the tracheostoma and surrounding cutaneous defects. The deltopectoral flap provides a large volume of well-vascularized tissue that provides reliable coverage of the newly reconstructed cervical esophagus and exposed major vessels following exenteration of the central compartment. Its thin, pliable nature allows suturing of the tracheal remnants to skin edges without tension and avoids intraluminal prolapse of excess soft tissues, thus maintaining stomal patency.
Keywords:	adult; clinical article; treatment outcome; aged; aged, 80 and over; middle aged; surgical technique; reconstructive surgical procedures; retrospective studies; cancer recurrence; head and neck surgery; squamous cell carcinoma; carcinoma, squamous cell; cutaneous fistula; fistula; pharyngeal diseases; surgical flaps; follow up; neoplasm recurrence, local; pectoralis major muscle; surgical approach; vascularization; latissimus dorsi flap; retrospective study; postoperative complication; soft tissue; head and neck neoplasms; graft survival; free tissue graft; myocutaneous flap; pharyngocutaneous fistula; suturing method; tracheostomy; airway; jejunum; larynx disorder; esophagus reconstruction; evisceration; digestive system; pharynx disease; tracheotomy; deltopectoral flap; esophagus malformation; microvascular free jejunal transfer
Journal Title:	Plastic and Reconstructive Surgery
Volume:	115
Issue:	5
ISSN:	0032-1052
Publisher:	Lippincott Williams & Wilkins
Date Published:	2005-04-15
Start Page:	1304
End Page:	1310
Language:	English
DOI:	10.1097/01.prs.0000156916.82294.98
PUBMED:	15809590
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-16844371829&partnerID=40&md5=60457454087ab69aee5eeb237a6ce18a
Notes:	--- - "Cited By (since 1996): 13" - "Export Date: 24 October 2012" - "CODEN: PRSUA" - "Source: Scopus"

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