Yamamoto Y, Minakawa H, Okushiba S, Motohara T
Department of Plastic and Reconstructive Surgery, Hokkaido University, Sapporo, Japan.
J Reconstr Microsurg. 1997 May;13(4):285-9. doi: 10.1055/s-2007-1000237.
Use of the gastric pedicle is an established method for esophageal reconstruction. However, fistula or necrosis of the pedicle occasionally occur due to vascular insufficiency or the severity of the surgery. During the past 4 years, the authors encountered six patients with necrosis of the gastric pedicle, who required reconstruction of circumferential defects of the cervical and thoracic esophagus. In such secondary reconstructive cases, primary closure of the wound is very difficult because the surrounding soft tissue becomes fibrous from infectious and fistulous complications of the first operation. Free jejunal transfers were utilized for restoring continuity of the alimentary tract, a platysma myocutaneous and pectoral fasciocutaneous flap for covering the intestinal anastomoses, and a mesenteric flap connected with the jejunal graft for covering the remaining skin defects in these cases. In follow-up periods from 3 to 21 months, satisfactory results were obtained in all but one patient. Five patients could eat a normal diet without difficulty. This reconstructive method is advocated as safe and well-tolerated physiologically in the salvage of necrosis of the gastric pedicle.
使用带蒂胃是食管重建的一种成熟方法。然而，由于血管供血不足或手术的复杂性，蒂部偶尔会出现瘘管或坏死。在过去4年中，作者遇到6例胃蒂坏死患者，他们需要重建颈段和胸段食管的环形缺损。在这类二次重建病例中，由于首次手术的感染和瘘管并发症导致周围软组织纤维化，伤口的一期缝合非常困难。在这些病例中，采用游离空肠移植来恢复消化道的连续性，用颈阔肌肌皮瓣和胸大肌筋膜皮瓣覆盖肠吻合口，并用与空肠移植物相连的肠系膜瓣覆盖剩余的皮肤缺损。在3至21个月的随访期内，除1例患者外，其余患者均取得了满意的结果。5例患者能够顺利进食正常饮食。这种重建方法被认为在挽救胃蒂坏死方面是安全的，并且在生理上耐受性良好。
