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首页> 外文期刊>Plastic and reconstructive surgery >Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration.
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Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration.

机译：中央颈动脉放出后结合气管上皮瓣和微血管游离空肠转移结合气管和颈段食管。

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摘要

BACKGROUND: Combined defects of the skin, larynx, pharynx, and esophagus after central compartment exenteration of the neck can be extremely difficult to reconstruct. The objective of this article is to evaluate reconstruction of the central compartment using a combination of free jejunal transfer for pharyngoesophageal reconstruction, together with regional deltopectoral flaps for tracheostomal reconstruction and cutaneous resurfacing. Myocutaneous flaps, such as pectoralis major and latissimus dorsi flaps, have been used previously for external coverage but can be bulky, causing obstruction of the tracheostoma. METHODS: From 1995 to 2002, seven patients underwent reconstruction of the central compartment with seven jejunal and nine deltopectoral flaps. Five patients required resection for tracheostomal recurrence of squamous cell carcinoma, and two patients required resection for massive pharyngocutaneous fistulas. Flap survival, complications, and outcomes were evaluated retrospectively. RESULTS: The mean age of the patients was 68.7 years and the mean length of follow-up was 1.9 years. Overall free jejunal and deltopectoral flap survival was 100 percent, with no partial loss. All patients maintained an adequate airway with stomal patency. CONCLUSIONS: These complicated defects can be effectively repaired with free jejunal transfers to restore continuity of the alimentary tract and deltopectoral flaps to reconstruct the tracheostoma and surrounding cutaneous defects. The deltopectoral flap provides a large volume of well-vascularized tissue that provides reliable coverage of the newly reconstructed cervical esophagus and exposed major vessels following exenteration of the central compartment. Its thin, pliable nature allows suturing of the tracheal remnants to skin edges without tension and avoids intraluminal prolapse of excess soft tissues, thus maintaining stomal patency.
机译：背景：颈部中央腔室拔出后皮肤，喉，咽和食道的综合缺陷可能非常难以重建。本文的目的是评估结合使用空肠空肠转移进行咽食管重建，结合局部三角肌皮瓣进行气管切开重建和皮肤表面置换来评估中央室的重建。肌皮瓣，如大胸大肌和背阔肌皮瓣，以前曾用于外部覆盖，但可能体积较大，导致气管造口阻塞。方法：从1995年到2002年，有7例患者接受了7例空肠和9例三角肌皮瓣的中隔重建。 5例因气管镜切除的鳞状细胞癌复发而需要切除，2例因大咽咽皮肤瘘而切除。皮瓣生存，并发症和结果进行了回顾性评估。结果：患者的平均年龄为68.7岁，平均随访时间为1。9年。空肠和腹膜上皮瓣的总游离存活率为100％，无部分丢失。所有患者保持呼吸道通畅，气道通畅。结论：可通过空肠自由转移有效修复这些复杂的缺损，以恢复消化道和腹鳍的皮瓣的连续性，以重建气管造口和周围皮肤缺损。三角肌皮瓣可提供大量血管良好的组织，从而在中央腔室伸张后可靠覆盖新近重建的宫颈食道和暴露的主要血管。其薄而柔韧的性质允许将气管残余物缝合到皮肤边缘而无张力，并且避免腔内多余的软组织脱出，从而保持口腔通畅。

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