Kelly K E, Anthony J P, Singer M
Department of Otolaryngology-Head and Neck Surgery, Mt. Zion Medical Center, University of California, San Francisco 94115.
Otolaryngol Head Neck Surg. 1994 Jul;111(1):16-24. doi: 10.1177/019459989411100106.
Pharyngoesophageal reconstruction remains a challenge to the head and neck surgeon. The goals of pharyngoesophageal reconstruction include restoration, with minimal morbidity, of a person's ability to swallow and to speak. Myocutaneous flaps, gastric pull-up, and the jejunal free flap are popular methods of pharyngoesophageal reconstruction; however, none of these modalities is clearly ideal. We have begun utilizing the radial forearm fasciocutaneous free flap for pharyngoesophageal reconstruction. Twelve patients have had reconstruction with this flap with follow-up from 2 to 15 months. Seven defects were circumferential, and five were noncircumferential. Ten patients (83%) have had successful restoration of both swallowing ability and voice. Donor site morbidity was minimal. The leading complication was salivary leak, which was present in eight (67%) patients. Five of the leaks closed with nonsurgical intervention. No cases of flap necrosis occurred. The radial forearm free flap is a thin and pliable flap that closely approximates the tissue consistency of normal pharynx. Successful restoration of a patient's ability to swallow approximates that of enteral flaps and is superior to that of MC flaps. Successful speech restoration is superior to that of enteral and MC flaps. Donor site morbidity is less than that caused by enteral flaps because laparotomy is avoided. Salivary leak is higher than with enteral flaps. Part of this difference is accountable to the high number of secondary and technically challenging reconstructions in this series, and we have taken steps to lower this rate of leakage. These preliminary data show that the radial forearm fasciocutaneous free flap is well suited for pharyngoesophageal reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
咽食管重建术对头颈外科医生来说仍是一项挑战。咽食管重建的目标包括以最小的发病率恢复患者的吞咽和说话能力。肌皮瓣、胃上提术和空肠游离瓣是咽食管重建的常用方法；然而，这些方法都并非明显理想。我们已开始使用桡侧前臂筋膜皮瓣进行咽食管重建。12例患者接受了该皮瓣重建，随访时间为2至15个月。7例缺损为环形，5例为非环形。10例患者（83%）吞咽能力和嗓音均成功恢复。供区并发症极少。主要并发症为唾液漏，8例（67%）患者出现该情况。其中5例漏口经非手术干预后愈合。未发生皮瓣坏死病例。桡侧前臂游离瓣薄且柔韧，其组织质地与正常咽部相近。患者吞咽能力的成功恢复情况与肠瓣相近，且优于肌皮瓣。语音恢复成功情况优于肠瓣和肌皮瓣。由于避免了开腹手术，供区并发症少于肠瓣。唾液漏发生率高于肠瓣。部分差异归因于本系列中二次手术及技术难度大的重建手术数量较多，我们已采取措施降低这种漏液发生率。这些初步数据表明，桡侧前臂筋膜皮瓣非常适合咽食管重建。（摘要截选至250字）
