Donor-site morbidity after free ileocolon flap transfer for esophageal and voice reconstruction.
BACKGROUND
Radical excision of advanced hypopharyngeal and laryngeal tumors usually compromises both swallowing and speech. Among the available reconstruction methods, the free ileocolon flap allows rehabilitation of both functions in one stage. The donor-site morbidity of this flap has not been addressed in head and neck cancer patients.


METHODS
A retrospective study was conducted in 34 patients between April of 2003 and December of 2007 to investigate donor-site morbidity in patients undergoing reconstruction with free ileocolon flaps. Complications such as diarrhea, upper gastrointestinal tract distress, bowel leak, abscess, or hernia formation were evaluated. Significant association of diarrhea and upper gastrointestinal distress, previous abdominal operations, systemic diseases, primary versus secondary reconstruction, flap length, and postoperative chemotherapy were subsequently evaluated. Differences were considered significant for values of p <or= 0.05.


RESULTS
There were no perioperative or postoperative deaths. Nineteen patients (56 percent) experienced temporary diarrhea. In all but two patients, diarrhea discontinued by 4 months. Chemotherapy was significantly associated with diarrhea (p < 0.01). Colchicine, terbinafine, and heroin withdrawal episodically caused diarrhea but statistical conclusions could not be drawn. Six patients (18 percent) suffered from upper gastrointestinal tract problems (gastroduodenal ulcer, erosive gastritis, and minor bleeding), probably because of insufficient gastric protection.


CONCLUSIONS
The free ileocolon flap proved to be a reliable method when simultaneous restoration of swallowing and speech was required, with donor-site morbidity comparable to that of the other intestinal flaps.
Rampazzo
Antonio
A
Taiwan, Republic of China; Cleveland, Ohio; and Rochester, Minn. From the Department of Plastic Surgery, E-Da Hospital, I-Shou University, the Department of Plastic Surgery, University Hospitals Cleveland, Case Western Reserve University, and the Division of Plastic Surgery, Mayo Clinic.
Salgado
Christopher J
CJ
Gharb
Bahar Bassiri
BB
Mardini
Samir
S
di Spilimbergo
Stefano Spanio
SS
Chen
Hung-Chi
HC
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003679:Deglutition; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000473:pathology / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery; D010611:Pharyngectomy; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects*; D014831:Voice