Ileocolic free flap for voice and swallowing rehabilitation after pharyngolaryngo-esophagectomy: a preliminary report
Merlino, G.; Bergamin, F.; Borsetti, G.
Add Journal to My Library European Journal of Plastic Surgery , Volume 23 (5) – Jul 17, 2000
Abstract The usual approach for patients with advanced
hypopharyngeal cancer is a multimodal treatment with
surgical resection and radiation therapy. A circular pha-
ryngolaryngoesophagectomy is mandatory in cases with
advanced disease, even if it extends above the upper
esophageal sphincter, followed by an immediate recon-
struction. A microsurgical reconstructive technique is
advised, based on Kawahara’s technique, using an ileo-
colic free flap as a single stage procedure for voice and
swallowing rehabilitation. A total of four patients with
advanced squamous cell carcinoma of the oropharynx
was submitted to surgery. After pharyngolaryngoesopha-
gectomy, the ileocolic complex was transposed and re-
vascularized in the cervical field; the digestive tract res-
toration was performed with the cecum and ascending
colon, while the last ileal loop was anastomosed to the
cervical trachea. The continence mechanism of the ileo-
cecal valve was used to protect the airways from inhala-
tion of food and saliva and to obtain a monotonic phona-
tion. A tracheal stoma was maintained to permit satisfac-
tory breathing. All patients underwent this procedure
successfully, with recovery of swallowing function and
vocal performance within a short time, varying from 18
to 38 days.
published a new surgical method for the single stage re-
construction of the upper aerodigestive tract. They intro-
duced the concept of a free ileocolic graft for voice resto-
ration using the mechanism of the ileocolic valve.
Over the past year, we have tried to perfect this tech-
nique with two variants, as a preliminary study to pro-
duce voice restoration without an external valve and tra-
cheostomy. This has also been used in patients with ex-
tensive laryngectomies.
Operative technique
First step: tracheostomy
Cervical resection and bilateral neck dissection (radical or modi-
fied) pharyngo- or hemipharyngolaryngoesophagectomy with bi-
lateral tracheoesophageal groove lymph node dissection, hemithy-
roidectomy or subtotal thyroidectomy (Fig. 1). The resection must
obtain free tumor margins of at least 2 cm. In this step the cervical
artery and veins are explored for the reconstruction.