Matsumine Hajime, Kubo Kazuyuki, Hamahata Atsumori, Sakurai Hiroyuki
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2017 Aug 18;5(8):e1444. doi: 10.1097/GOX.0000000000001444. eCollection 2017 Aug.
Free jejunal transfer has a high success rate, but if vascular thrombosis occurs, the salvage of failing flap with reanastomosis is difficult. This study described a combined deltopectoral (DP) and pectoralis major musculocutaneous (PMMC) flap 2-step technique for cervical esophageal reconstruction after free-jejunal-flap necrosis.
In step 1, the detection of free jejunal flap with the subsequent debridement of necrotic and infected tissue was followed by the construction of external fistula on the pharyngeal side with the hole in cervical skin and the construction of another external fistula on the esophageal side and tracheal stoma with a single or double DP flap. In step 2, after the primary healing of all wounds was confirmed, a wide hinge flap was elevated for reconstructing the posterior wall or full circumferential defect of cervical esophagus. PMMC flap harvested from either the left or right anterior chest wall was used for reconstructing the cervical surface defect or anterior pharyngeal wall.
This technique was used for cervical esophageal reconstruction after free-jejunal-flap necrosis in 5 patients. Step 1 surgery was performed at an average of 10 days after primary-free-jejunal flap transfer. Oral intake was resumed in all cases at an average of 117 days after step 2 surgery. No complications including esophageal stricture were found during a 6-month follow-up period.
Combined DP and PMMC flap technique was useful for cervical esophageal reconstruction after free-jejunal-flap necrosis and applicable to patients with the late detection of jejunal necrosis and surgical-site infection.
游离空肠移植成功率较高，但如果发生血管血栓形成，通过重新吻合挽救失败的皮瓣则很困难。本研究描述了一种联合三角胸肌（DP）瓣和胸大肌肌皮（PMMC）瓣的两步技术，用于游离空肠瓣坏死术后的颈段食管重建。
第一步，检测游离空肠瓣，随后清创坏死和感染组织，接着在咽侧通过颈部皮肤打孔构建外瘘，并使用单瓣或双瓣DP瓣在食管侧和气管造口处构建另一个外瘘。第二步，确认所有伤口一期愈合后，掀起一个宽蒂皮瓣以重建颈段食管的后壁或全周缺损。从左或右前胸壁切取的PMMC瓣用于重建颈部表面缺损或咽前壁。
该技术用于5例游离空肠瓣坏死术后的颈段食管重建。第一步手术平均在初次游离空肠瓣移植后10天进行。第二步手术后平均117天所有患者均恢复经口进食。在6个月的随访期内未发现包括食管狭窄在内的并发症。
联合DP瓣和PMMC瓣技术对游离空肠瓣坏死术后的颈段食管重建有用，适用于空肠坏死发现较晚及手术部位感染的患者。
