Mochizuki Yasushi, Ueda Kazuki, Okochi Masayuki, Kajikawa Akiyoshi
Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan.
J Plast Reconstr Surg. 2024 Oct 11;4(2):81-86. doi: 10.53045/jprs.2024-0006. eCollection 2025 Apr 27.
Three cases of total thoracic esophageal re-reconstruction after failed jejunum grafting for esophageal cancer are described. A prefabricated long skin tube formed by a combination of tensor fascia lata and anterolateral thigh flaps was transferred to the ruined anterior chest with vascular anastomosis, with the oral intake achieved in all three patients. The prefabrication reinforced the vascularity of the long conduit by the delay effect. The prefabrication included skin grafting on the resultant raw surface; hence, another free flap to seal the longitudinal suture line of the conduit was avoided. Furthermore, the viability of the conduit was easily monitored with the previously grafted skin. However, if a high-positioned jejunostomy is unavailable, an additional free skin tube might be necessary. Postoperative leakage is quite frequent due to these patients' poor general and local conditions. Therefore, sparing large local flaps or pedicled musculocutaneous flaps around both the oral and anal anastomoses for repairing the fistula is important.
本文描述了3例食管癌空肠移植失败后进行全胸段食管再次重建的病例。采用阔筋膜张肌和股前外侧皮瓣联合形成的预制长皮管，通过血管吻合转移至毁损的前胸壁，3例患者均实现了经口进食。预制通过延迟效应增强了长管道的血运。预制包括在形成的创面进行植皮；因此，避免了使用另一游离皮瓣来封闭管道的纵向缝合线。此外，通过先前移植的皮肤可轻松监测管道的存活情况。然而，如果无法进行高位空肠造口术，则可能需要额外的游离皮管。由于这些患者全身和局部状况较差，术后渗漏相当常见。因此，保留口腔和肛门吻合口周围的大型局部皮瓣或带蒂肌皮瓣用于修复瘘管很重要。
