Voice reconstruction with free ileocolon flap transfer: implications for the lower respiratory tract.

BACKGROUND

Free ileocolon flap surgery is an effective technique for voice reconstruction in hypopharyngolaryngectomy defects. A tracheoesophageal fistula is created using an intestinal conduit characterized by secretions and a resident microbial flora. The aim of this study was to investigate the respiratory complications and modifications of the regional flora following ileocolon flap transfer.

METHODS

A retrospective study was conducted on 35 patients who underwent voice reconstruction with the free ileocolon flap. The prevalence of respiratory symptoms, aspiration, and respiratory tract infections was studied and the management of respiratory complications was recorded. Ten patients were included in a cross-sectional study to evaluate the bacterial flora of the voice tube and the tracheostomy site.

RESULTS

Six patients experienced aspiration of food into the trachea caused by incompetence of the ileocecal valve (n = 5) or pathologic tracheoesophageal fistula (n = 1). Four patients presented with pneumonia. In one case, pneumonia was consequent to aspiration caused by incompetence of the ileocecal valve. Radiotherapy, chemotherapy, and age older than 55 years did not influence the continence of the ileocecal valve. Mean follow-up was 34.2 months. Escherichia coli was the organism cultured most frequently.

CONCLUSIONS

Reconstruction with the free ileocolon flap was shown to be a possible therapeutic option when considering the consequences on the lower respiratory tract. Aspiration was the main complication and was avoided by internal plication of the valve and by reduction of the ileocecal angle. Awareness of the nature of the bacterial flora colonizing the trachea and voice tube could be helpful in guiding the empirical antibiotic therapy in case of infection.