Escandón Joseph M, Santamaría Eric, Prieto Peter A, Duarte-Bateman Daniela, Ciudad Pedro, Pencek Megan, Langstein Howard N, Chen Hung-Chi, Manrique Oscar J
Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York.
Department of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Cancer Institute, Mexico City, Mexico.
Arch Plast Surg. 2022 May 27;49(3):378-396. doi: 10.1055/s-0042-1748652. eCollection 2022 May.
Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.
据报道，有几种重建方法可用于恢复下咽癌和喉咽癌切除术后气道消化道的连续性。然而，据报道，在插入语音假体后并发症发生率很高。在这种情况下，回结肠游离皮瓣（ICFF）提供了一种管状皮瓣，用于下咽重建，同时提供一个自然的发声管。在此，我们系统地回顾了目前关于使用ICFF重建气道消化道的证据。通过PubMed MEDLINE、科学网、ScienceDirect、Scopus和Ovid MEDLINE(R)进行了系统的文献检索。提取了关于技术考量以及手术和功能结果的数据。纳入了21项研究。平均年龄和随访时间分别为54.65岁和24.72个月。可根据患者需求使用顺蠕动或逆蠕动标准ICFF、补片皮瓣或嵌合浆肌层-ICFF。浆肌层嵌合皮瓣有助于加强远端吻合口的闭合。7至15厘米的回肠段的最大发声时间、频率和声压级（分贝）更高。术后渗漏发生率为0%至13.3%，大多数发生在结肠食管交界处。微血管吻合的翻修率为0%至16.6%。ICFF为气道消化道中等大小缺损的重建提供了一种可靠且通用的替代方法。其三维结构和功能解剖有利于早期言语和吞咽，无需人工瓣膜，供区并发症最少。
