Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
St Andrew's Center for Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK.
Eur J Cardiothorac Surg. 2019 Feb 1;55(2):286-291. doi: 10.1093/ejcts/ezy251.
The free anterolateral thigh (ALT) flap is commonly used for the reconstruction of the cervical oesophagus with satisfactory results. Its convenience and popularity make it a popular flap for reconstructive surgeons. The use of intestinal flaps, however, carries a higher level of technical difficulty and is normally performed as a primary reconstructive procedure. This report investigates the feasibility of intestinal flaps for the reconstruction of the cervical oesophagus and strategies to optimize its success when used as a secondary flap after primary ALT flap failure.
We retrospectively reviewed 22 patients (age 39-72 years) who were men, between April 2013 and January 2015, with intestinal segments (free and pedicled ileocolon, jejunal and colon flaps) that were used secondarily to salvage failed primary free ALT flap reconstructions after hypopharyngeal cancer resection. Ten patients presented with leakage and 2 with tracheo-oesophageal fistulae as complications from the primary flap failure.
Oral intake commenced around 1-month postoperatively. One case of flap failure was observed. The majority had no major postoperative complications. Patients were followed up (6-27 months), and 21 cases of a secondary intestinal flap were successful with the restoration of oesophageal continuity and oral intake.
Intestinal flaps, free or pedicled, can be used secondarily after failed ALT flap reconstructions with minimal complications or morbidity. Intestinal flaps successfully allow restoration of gastrointestinal continuity with early commencement of oral intake and swallowing function.
游离股前外侧（ALT）皮瓣常用于重建颈段食管，效果满意。因其便利性和普及性，成为重建外科医生常用的皮瓣。然而，肠瓣的使用技术难度更高，通常作为主要重建步骤进行。本研究旨在探讨肠瓣重建颈段食管的可行性，以及在 ALT 皮瓣失败后作为二期皮瓣使用时优化其成功率的策略。
我们回顾性分析了 2013 年 4 月至 2015 年 1 月期间 22 例男性患者的临床资料，这些患者均因下咽癌切除术后原发性游离 ALT 皮瓣重建失败，使用肠段（游离和带蒂回结肠、空肠和结肠瓣）进行二期修复。10 例患者因原发性皮瓣失败出现漏口，2 例患者出现气管食管瘘。
术后 1 个月左右开始经口进食。观察到 1 例皮瓣失败。大多数患者无重大术后并发症。患者接受了（6-27）个月的随访，21 例二期肠瓣重建成功，食管连续性和经口进食得以恢复。
游离或带蒂的肠瓣可在 ALT 皮瓣重建失败后作为二期皮瓣使用，并发症少，发病率低。肠瓣可成功恢复胃肠道连续性，早期恢复经口进食和吞咽功能。
