Background
Defects involving hypopharynx, cervical, and thoracic esophagus are challenging to
reconstruct, and the available procedures usually leave patients voiceless. We describe
our experience with a modified pedicled ileocolon flap for the reconstruction of alimentary
conduit and voice in patients undergoing hypopharyngo-laryngectomy and total esophagectomy.
Methods
Between January 1995 and December 2008, 7 patients underwent reconstruction of the
digestive tract and voice function with a pedicled ileocolon flap because of extensive
defects involving larynx, hyphopharynx, cervical, and thoracic esophagus. Patient's
charts were reviewed and appropriate clinical data were evaluated.
Results
All patients were male with a mean age of 58 years. The continuity of the digestive
tract was restored with ileum-colon (n = 1) or colon (n = 6). The voice tube was reconstructed with appendix (n = 1) or with terminal ileum (n = 6). The middle colic artery (n = 1) and left ascending colic artery (n = 6) were used as a pedicle. Five flaps were supercharged using ileocolic vessels.
All the flaps survived completely. No intraoperative or in-hospital mortalities occurred.
The mean hospital stay was 40 days. The mean follow-up was 22.4 months. Two patients
died of local recurrence (1 patient) and distant metastasis (1 patient). One patient
died of the complications of pre-existing disease. At the last follow-up, the median
deglutition score was 5/7. The median speech score for intelligibility and fluency
was 3, and 4 for loudness. The maximum phonation time was 7.57 s. The average sound
pressure loudness and fundamental frequency were, respectively, 59 ± 3 dB and 133
± 33 Hz.
Conclusion
The pedicled ileocolon flap as used in this series proved to be a safe and reliable
technique for simultaneous reconstruction of voice and digestive tract.
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Article info
Publication history
Published online: February 11, 2011
Accepted:
November 24,
2010
Footnotes
Supported by institutional funding of National Science Council, Republic of China.
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
