PDF(Pubmed)
Abstract：
Background: Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors\' experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients\' quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.
摘要：
背景：颈部食管重建术对提高癌症手术患者的生活质量至关重要。显微外科手术对于提供血管化组织进行缺损修复至关重要，特别是在继发病例中，由于以前的手术和放疗造成的较大缺陷和损伤而导致的失败风险较高。这项研究的目的是根据作者的经验和文献综述，描述一系列接受二次食管缺损修复的患者的临床特征，并为此类病例的管理和治疗提供实用信息。方法：我们回顾性回顾了的里雅斯特大学整形外科诊所的电子病历，以确定在肿瘤手术后接受二次食道显微外科重建的患者病例。患者人口统计学，食管缺损的病因,既往手术史,术前评估从病历中收集.用于重建的外科技术，如带蒂皮瓣或游离组织转移，与术中信息一起记录。术后结果,包括并发症,移植物活力，和功能结果，在随访期间进行了评估。结果：我们在2011年至2022年期间治疗了13例二次食管重建。最常见的是,应用股前外侧(ALT)皮瓣10例,而2例采用桡侧前臂皮瓣（RFF），1例采用嵌合的肩副皮瓣。在中位50个月的随访期间，没有发生皮瓣失败。一名ALT皮瓣患者经历了术后狭窄，但保持了吞咽能力。一名有放疗史和完整淋巴结清扫术的RFF患者发生了一次气管食管瘘。结论：颈部食管重建通过恢复口腔进食和发声显著影响患者的生活质量。当局部襟翼不足时,肠皮瓣的显微外科重建是有价值的，但有局限性。对于具有挑战性的次要案件，ALT或RFF皮瓣出现作为更安全的选择，由于其坚固的椎弓根，产生低并发症率和积极的功能结果。
