Motility Differences in Free Colon and Free Jejunum Flaps for Reconstruction of the Cervical Esophagus
- 1 November 2008
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 122 (5), 1410-1416
- https://doi.org/10.1097/prs.0b013e31818820f4
Abstract
Free colon and jejunal flaps have been described as reliable and safe conduits for pharyngoesophageal reconstruction. Compared with free colon flaps, free jejunum flaps have a smaller diameter and intrinsic peristaltic movement, both of which are considered possible causes of dysphagia. In this investigation, the authors evaluated motility differences in free jejunum and colon flaps using radionuclide esophageal scintigraphy. Patients who received free jejunum flaps (n = 12) or free colon (n = 1) or ileocolon flaps (n = 13) for reconstruction after pharyngoesophagectomy for cancer were included. Radionuclide esophageal scintigraphy was performed using technetium-99m-labeled sulfur colloid. Transit rate was evaluated at 1 second (pharyngeal or initial clearance) and 10 seconds (esophageal or clearance throughout). Clinical progression of swallowing was recorded postoperatively. Statistical analysis was performed using the t test. Mean pharyngeal clearance was 61 +/- 20 percent for free colon and ileocolon flaps and 70 +/- 16 percent for free jejunum flaps. Mean esophageal clearance was 50 +/- 27 percent for free colon and ileocolon flaps and 69 +/- 17 percent for free jejunum flaps. Esophageal transit rate was significantly shorter in patients who underwent reconstruction with free jejunum flaps (p = 0.04). At 1 year, 10 of 12 free jejunum patients and eight of 14 patients were tolerating solid foods. Although neither flap showed normal swallowing characteristics, free jejunum flaps displayed greater esophageal clearance and should represent the first choice in hypopharyngeal reconstruction. Free colon and ileocolon flaps should be reserved for very proximal oropharyngeal defects and when simultaneous voice reconstruction is desired.Keywords
This publication has 20 references indexed in Scilit:
- Functional outcomes of two types of subtotal colectomy for slow-transit constipation: ileosigmoidal anastomosis and cecorectal anastomosisThe American Journal of Surgery, 2008
- Inverted, stapled J‐pouch free jejunal transfer for reconstruction of the pharynx and esophagusJournal of Surgical Oncology, 2007
- Voice reconstruction using the free ileocolon flap versus the pneumatic artificial larynx: a comparison of patients' preference and experience following laryngectomyJournal of Plastic, Reconstructive & Aesthetic Surgery, 2006
- Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty for reconstruction of a pharyngoesophageal defect: indication and usage of the ‘funnel flap’Journal of Plastic, Reconstructive & Aesthetic Surgery, 2006
- Esophagus reconstruction with free jejunal transferMicrosurgery, 2006
- Intussusception of a Transferred Jejunal Flap in Cervical Esophagus ReconstructionAnnals of Plastic Surgery, 2005
- Esophageal hypomotility in systemie sclerosis: Close relationship with pulmonary involvementAnnals of Nuclear Medicine, 2001
- Free jejunum transfers for functional reconstruction after tumour resections in the oral cavity and the pharynx: Changes of morphology and functionMicrosurgery, 1996
- Morbidity and Functional Outcome of Free Jejunal Transfer Reconstruction for Circumferential Defects of the Pharynx and Cervical EsophagusPlastic and Reconstructive Surgery, 1995
- Microvascular reconstruction of the pharyngoesophagus with free jejunal graftMicrosurgery, 1988