원통모양의 유리 전박 피판으로 경부 식도의 재건 = PHARYNGOESOPHAGEAL RECONSTRUCTION WITH A TUBED FREE RADIAL FOREARM FLAP

다국어 초록 (Multilingual Abstract)

Various reconstruction of pharyngoesophageal defects after ablative surgery have been made to restore functions of the pharyngoesophagus. A tubed free radial forearm flap was used to reconstruct the pharyngoesophagus is 23 patients after resection of neoplasms from May 1989 to October 1994. 19 were male and 4 were female. Average patient age 62.2 years. Follow-up period ranged 10 to 64 months with mean 18 months. Oral intake within 3 weeks was possible in 18 patients(78%). 19patients(82%) were discharged within 4 weeks. The immediate postoperative complications were hematoma (n=1), bleeding(n=2), infection(n=3), fistula(m=4), and venous thrombosis(n=1). The late complication was stricture of lower anastomosing site (n=3).
The tubed free radial forearm flap had advantages over free jejunal transfer : Larger caliber of the vascular pedicle, longer ischemic time, no laparotomy with less morbidity of the donor site and better toleration to the radiotherapy. Troublesome disadvantages were stricture and fistula formation at suture sites.
We modified conventional free radial forearm flap to reduce the complications.
1. A small monitoring flap supplied by the septocutaneous branch of the radial artery was elevated to check the survival of the flap.
2. During tubing, the longitudinal suture site was overlapped with a deepithelialized skin flap and double layer sutures were done to prevent the fistula.
3. Two small triangular flaps were designed and inserted in the distal anastomotic site to prevent circular contracture. The outer layer sutures were anchored to surrounding rigid structure to withstand shrinkage and circular contraction.
With this modification, the incidence of stricture and fistula formation was reduced to 13.0% 17.4% respectively and these complication could be treated conservatively.