title: Simultaneous restoration of voice function and digestive tract continuity in patients with synchronous primaries of hypopharynx and thoracic esophagus with pedicled ileocolon flap.
abstract: BACKGROUND
  Defects involving hypopharynx, cervical, and thoracic esophagus are challenging to reconstruct, and the available procedures usually leave patients voiceless. We describe our experience with a modified pedicled ileocolon flap for the reconstruction of alimentary conduit and voice in patients undergoing hypopharyngo-laryngectomy and total esophagectomy.
  
  
  METHODS
  Between January 1995 and December 2008, 7 patients underwent reconstruction of the digestive tract and voice function with a pedicled ileocolon flap because of extensive defects involving larynx, hyphopharynx, cervical, and thoracic esophagus. Patient's charts were reviewed and appropriate clinical data were evaluated.
  
  
  RESULTS
  All patients were male with a mean age of 58 years. The continuity of the digestive tract was restored with ileum-colon (n = 1) or colon (n = 6). The voice tube was reconstructed with appendix (n = 1) or with terminal ileum (n = 6). The middle colic artery (n = 1) and left ascending colic artery (n = 6) were used as a pedicle. Five flaps were supercharged using ileocolic vessels. All the flaps survived completely. No intraoperative or in-hospital mortalities occurred. The mean hospital stay was 40 days. The mean follow-up was 22.4 months. Two patients died of local recurrence (1 patient) and distant metastasis (1 patient). One patient died of the complications of pre-existing disease. At the last follow-up, the median deglutition score was 5/7. The median speech score for intelligibility and fluency was 3, and 4 for loudness. The maximum phonation time was 7.57 s. The average sound pressure loudness and fundamental frequency were, respectively, 59 ± 3 dB and 133 ± 33 Hz.
  
  
  CONCLUSIONS
  The pedicled ileocolon flap as used in this series proved to be a safe and reliable technique for simultaneous reconstruction of voice and digestive tract.
authors.affiliation: Plastic Surgery Department, China Medical University Hospital, Taichung, Taiwan. D19722@mail.cmuh.org.tw
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
authors.forename: Bahar Bassiri
authors.initials: BB
authors.lastname: Gharb
authors.forename: Antonio
authors.initials: A
authors.lastname: Rampazzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Perrone
authors.forename: Shih-Heng
authors.initials: SH
authors.lastname: Chen
authors.forename: Emilio
authors.initials: E
authors.lastname: Trignano
mesh_terms: D003106:Colon / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D004944:Esophagoplasty / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000502:physiology* / Q000601:surgery; D006801:Humans; D007013:Hypopharynx / Q000601:surgery*; D007082:Ileum / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D010610:Pharyngeal Neoplasms / Q000601:surgery; D010611:Pharyngectomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome; D014831:Voice / Q000502:physiology*