Lin You-Cheng, Hsiao Jenn-Ren, Lee Yao-Chou
Division of Plastic and Reconstructive Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Microsurgery. 2017 Jul;37(5):426-430. doi: 10.1002/micr.30028. Epub 2016 Jan 22.
Esophageal stricture after surgery or trauma is a major reason for poor oral nutrition, body-weight loss, and general damage to health. Patch esophagoplasty, after repeated failed dilation attempts, is recommended for focal esophageal strictures. In this report, we present a case in which a free proximal lateral leg flap was used for reconstruction of focal stricture of the cervical esophagus. A 62-year-old man developed progressive dysphagia after hypopharyngeal cancer ablation and adjuvant radiotherapy. He was referred for surgical interventions after repeated failed dilation attempts. Preoperative evaluation revealed a 3-cm segment stricture of the cervical esophagus without evidence of an additional distal stricture. Patch esophagoplasty with free tissue transfer was planned. After the stricture site had been explored, the fibrotic tissue was resected. A pathology report confirmed no evidence of malignancy. The resultant defect in an otherwise healthy posterior esophageal wall was reconstructed using a proximal lateral leg flap. Recovery was uneventful and the functional outcome was satisfactory at the 6-month follow-up. For the radiated patients with cervical esophageal focal strictures, we introduced a novel use of the proximal lateral leg flap in patch esophagoplasty because of its unnoticeable donor site morbidity and its thin and pliable nature. © 2016 Wiley Periodicals, Inc. Microsurgery 37:426-430, 2017.
手术后或外伤后食管狭窄是导致经口营养状况差、体重减轻及总体健康受损的主要原因。对于局灶性食管狭窄，在反复扩张尝试失败后，推荐采用补片食管成形术。在本报告中，我们介绍了一例使用游离小腿近端外侧皮瓣重建颈段食管局灶性狭窄的病例。一名62岁男性在下咽癌切除及辅助放疗后出现进行性吞咽困难。在反复扩张尝试失败后，他被转诊接受手术干预。术前评估显示颈段食管有一个3厘米长的节段性狭窄，无远端额外狭窄的证据。计划采用带游离组织移植的补片食管成形术。探查狭窄部位后，切除纤维化组织。病理报告证实无恶性肿瘤证据。使用小腿近端外侧皮瓣重建了原本健康的食管后壁所形成的缺损。恢复过程顺利，6个月随访时功能结果令人满意。对于患有颈段食管局灶性狭窄的放疗患者，我们介绍了小腿近端外侧皮瓣在补片食管成形术中的一种新用途，因为其供区并发症不明显，且质地薄而柔韧。© 2016威利期刊公司。显微外科学37:426 - 430，2017。
