title: Subcutaneous placement of a free jejunum and pedicled colon segment to create a diversionary conduit for total esophageal reconstruction.
abstract: In this report, we describe a case of difficult esophageal reconstruction with a pedicled colon segment interposition and a free jejunal flap. Laryngectomy and bilateral neck dissection for larynx carcinoma had been attempted in a 59-year-old patient 6 years previously. The patient then received radiotherapy. One year later, large resection was performed due to recurrence of the tumor. Since then the patient had been fed through a gastrostomy tube. Previous attempts at esophageal reconstruction in other institutions were unsuccessful. We reconstructed the total esophagus with subcutaneously tunneled pedicled colon segment interposition and a free jejunal flap using the diversionary loop technique to divert the passage of the foot from the pharynx to the new inlet at the buccogingival sulcus, thus keeping the native esophagus untouched. Following a postoperative training period, the patient learned to swallow successfully and smoothly via the new inlet. The patency of the newly reconstructed esophagus was corroborated by radiological imaging. In summary, although the technique requires complex surgical procedures, it is effective and may be considered as an alternative and reliable option in selected cases.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey. omozkan@hotmail.com
authors.forename: Omer
authors.initials: O
authors.lastname: Ozkan
authors.forename: Ozlenen
authors.initials: O
authors.lastname: Ozkan
authors.forename: Gamze
authors.initials: G
authors.lastname: Bektas
authors.forename: Ani
authors.initials: A
authors.lastname: Cinpolat
authors.forename: Okan
authors.initials: O
authors.lastname: Erdogan
authors.forename: Suat
authors.initials: S
authors.lastname: Sanli
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
mesh_terms: D003106:Colon / Q000637:transplantation*; D004947:Esophagus / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019651:Plastic Surgery Procedures / Q000379:methods*