title: Tubed deltopectoral flap for creation of a controlled esophagocutaneous fistula in patients with persistent choking following esophageal reconstruction with free diversionary jejunum.
abstract: Esophageal reconstruction in patients with abnormal pharyngeal muscles or epiglottis may result in episodes of choking. The jejunal flap has been used to prevent choking by insetting the proximal end into the gingivobuccal sulcus and separating the digestive tract from the airway. A technique has been developed to deal with patients with aspiration due to collection of food near the nonfunctioning epiglottis. Between 1997 and 2004, 25 patients underwent reconstruction with jejunal flaps inset into the gingivobuccal sulcus. Postoperatively, 5 patients presented with episodes of choking. All patients underwent creation of an esophagocutaneous fistula using a deltopectoral flap. All flaps survived. Choking resolved and vocal performance was preserved in all patients. The jejunum, inset proximally into the gingivobuccal sulcus, has been successful in reconstructing patients unable to separate the airway from the digestive tract. The deltopectoral flap provides tissue for creation of a tubed flap and allows for the creation of a long fistula that prevents aspiration and can divert oral fluids away from a tracheostomy or a fresh wound.
authors.affiliation: Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan.
authors.forename: Omer
authors.initials: O
authors.lastname: Ozkan
authors.forename: Samir
authors.initials: S
authors.lastname: Mardini
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Salgado
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cigna
authors.forename: Guan-Ming
authors.initials: GM
authors.lastname: Feng
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000402:Airway Obstruction / Q000209:etiology*; D003680:Deglutition Disorders / Q000209:etiology*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D001239:Inhalation; D007583:Jejunum / Q000637:transplantation*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps