Use of the "supercharge" technique in esophageal and pharyngeal reconstruction to augment microvascular blood flow.
BACKGROUND
Although gastric tubes are commonly used in thoracic esophageal reconstruction, sometimes circumstances are such that an alternative method must be found. On these occasions, pedicled jejunum transfer and colonic interposition are used. After reconstruction, partial necrosis can occur because of poor blood flow in the oral end of the segment used to restore esophageal continuity. To improve this blood flow, we created a technique-the "supercharge" technique-in which we perform additional microvascular blood flow augmentation.


METHODS
The supercharge technique was performed in 82 esophageal reconstructions with microvascular blood flow augmentation. Reconstructive methods included a gastric tube in 5 patients, a gastric tube combined with a free jejunal graft in 2, an elongated gastric tube in 6, a pedicled colonic interposition in 26, and a pedicled jejunum in 43. Recipient vessels were located in the neck or chest regions.


RESULTS
After microvascular blood flow augmentation, the color and blood flow of the transferred intestine appeared greatly improved. During the operation, thrombosis was noticed in 3 patients and successfully salvaged by reanastomosis. Partial graft necrosis of the oral end of the segment occurred in only 2 patients; 2 patients had anastomotic leakage.


CONCLUSIONS
The risk of leakage and partial necrosis of the transferred gut conduit appear to be reduced by using the supercharge technique to augment microvascular blood flow. This reliable technique contributes to the successful reconstruction of esophageal defects.
Sekido
Mitsuru
M
Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Soshundo Plastic Surgery, and Keiyukai Sapporo Hospital, Sapporo, Japan.
Yamamoto
Yuhei
Y
Minakawa
Hidehiko
H
Sasaki
Satoru
S
Furukawa
Hiroshi
H
Sugihara
Tsuneki
T
Nohira
Kunihiko
K
Yajima
Kazuyoshi
K
Shintomi
Yoshihisa
Y
Okushiba
Syunichi
S
Kato
Hiroyuki
H
Hosokawa
Masao
M
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004947:Esophagus / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow; D014656:Vascular Surgical Procedures