Simultaneous Reconstruction of the Esophagus and Posterior Tracheal Wall Using a Combination of Free Jejunal and Mesenteric Flaps: A Case Report

IF 1.5 3区 医学 Q3 SURGERY Microsurgery Pub Date : 2024-11-01 DOI:10.1002/micr.31257
Keiichi Goishi, Yoshiro Abe, Hiroshi Harada, Kenta Ikushima, Mai Nakagawa, Shunsuke Mima, Ichiro Hashimoto
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Abstract

Free jejunal transfer is one of the most useful procedures for reconstructing circumferential defects following total pharyngolaryngoesophagectomy (TPLE). When an extended resection of the surrounding soft tissue is performed in addition to the TPLE, the defect may require another flap in addition to the jejunal flap to reconstruct the soft tissue defect. In such multiple defects, the choice of reconstruction method remains unanswered and unsolved. Herein, our objective was to clarify the utility of our newly developed technique of simultaneous reconstruction of two defects in the neck using a combination of free jejunal and mesenteric flaps. An 81-year-old man had defects in the upper esophagus, total larynx/pharynx, and posterior tracheal wall caused by the resection of invasive upper esophagus cancer anterior to the membranous part of the trachea. A chimera flap composed of a 15 cm free jejunal and mesenteric flap along with 15 cm of surplus mesentery was harvested; the jejunum was inserted into the esophageal defect and the mesentery was placed on the tracheal defect. The patient exhibited a favorable postoperative course at 8 months with no recurrence or stenosis in the reconstructed respiratory or gastrointestinal tract. This method offers a straightforward vessel anastomosis, making it a good and reasonable option for reconstructing partial tracheal defects along with TPLE.

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使用游离空肠瓣和肠系膜瓣同时重建食管和气管后壁:病例报告。
游离空肠转移术是重建全咽喉食管切除术(TPLE)后周缘缺损最有用的手术之一。如果除 TPLE 外还对周围软组织进行了扩大切除,则除空肠瓣外,可能还需要另一个瓣来重建软组织缺损。在这种多重缺损的情况下,重建方法的选择仍是一个悬而未决的问题。在此,我们的目的是明确我们新开发的技术的实用性,即使用游离空肠瓣和肠系膜瓣联合重建颈部的两处缺损。一名 81 岁的男性因切除气管膜部前方的浸润性上食管癌而导致上食管、全喉/咽和气管后壁缺损。切除了一个由 15 厘米游离空肠和肠系膜瓣以及 15 厘米多余肠系膜组成的嵌合瓣;将空肠插入食管缺损处,并将肠系膜置于气管缺损处。患者术后 8 个月病情良好,重建的呼吸道或胃肠道没有复发或狭窄。这种方法提供了直接的血管吻合,是重建部分气管缺损和 TPLE 的合理选择。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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