A new method of subcutaneous placement of free jejunal flaps to reconstruct a diversionary conduit for swallowing in complicated pharyngoesophageal injury.
Choking is a serious problem in pharyngoesophageal reconstruction, which may occur following tumor ablation of the pharynx or following corrosive injury involving the epiglottis and other parts of the upper airway. To prevent choking and the risk of severe pulmonary complications, patients have to give up oral intake and assume feeding via jejunostomy for the rest of their lives. After reconstruction of the esophagus, eight patients experienced frequent choking and aspiration. With a free jejunal flap, the inlet for food could be separated from the route of the upper airway by a diversion technique. The jejunum segment was transferred microsurgically to reconstruct the cervical esophagus, with its inlet at the buccogingival sulcus. There were no surgical complications related to either the free jejunal flap transfer or the donor site. Postoperatively, patients require re-education of their pattern of swallowing, but after the rehabilitation period all patients reported a satisfactory oral intake through the reconstructed esophagus to the abdomen without choking. There were no episodes of aspiration following reconstruction. With this new method to create a separate food pathway, patients can resume oral intake safely without choking and without permanent jejunostomy. This technique offers a useful solution for patients who suffer from recurrent choking and aspiration following injury or ablation of the pharynx.
Chen
Hung-chi
HC
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital. phoebe@ha.mc.ntu.edu.tw
Chana
Jagdeep S
JS
Chang
Chau-hsiung
CH
Feng
Guan-Ming
GM
Ho-Asjoe
Mark
M
Tang
Yeuh-bih
YB
D000328:Adult; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps
D002424:Caustics