Absence of the ileocolic artery: Microsurgical implications in reconstruction of the esophagus with the free ileocolon flap

Orfaniotis, Georgios; Saçak, Bülent; Nicoli, Fabio; Ciudad, Pedro; Lee, Chih Ying; Chen, Hung-Chi

doi:10.1002/micr.22392

Cited by 4 publications

(5 citation statements)

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“…30 47 Therefore, for a safe anastomosis, several authors have reported the transverse cervical artery (TCA) and external jugular vein as the preferred recipient vessels. 6 48 49 50 The TCA is usually uninjured by former ablative surgical procedures or radiation, has an exceptional size match for pedicles of intestinal flaps, and the risk of kinking is minimal. 6 48 50 Alternatively, recipient vessels that have been suggested when the ipsilateral TCA is unsuitable include the retrograde flow TCA, the superficial temporal artery (STA), thoracoacromial branches, the internal mammary artery with/without an interposing vein graft, contralateral neck vessels, and even branches of previous or simultaneous flaps.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

et al. 2022

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Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

et al. 2022

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“…In a case report by Orfaniotis et al . [5] there were, in fact, two closely coursing parallel arteries replacing the ICA, one colic and the other ileal, with a regular ICV between them. In our series, albeit having a distal ileocolic axis in place, we stated the ‘apparent’ ICA absence in cases where there was a single colic stem for the entire right colon, directed toward the hepatic angle of the colon.…”

Section: Discussionmentioning

confidence: 99%

“…Evidently, the anatomical features of the ileocolic vessels are of high significance in surgery for colorectal cancer, inflammatory bowel disease, mesenteric ischaemia or reconstruction of the oesophagus with an ileocolic flap [4,5]. The scholar anatomy of the visceral vasculature received additional wind in its sails with the advancement of complete mesocolic excision (CME) and the D3 lymphadenectomy of the right colon, introduced by Hohenberger et al .…”

Section: Introductionmentioning

confidence: 99%

“…The issue of the presence of ileocolic vessels is ambiguous in the literature. Their absence is noted in anecdotal reports [5], in reports from moderately sized series [12] or in prevalence reports from meta‐analyses [11], all without imaging documentation or morphometric data. The aim of the present study is to present unusual anatomy of ileocolic vessels, validated at surgery and relevant to CME, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Navigating the mesentery: Part III. Unusual anatomy of ileocolic vessels

Štimec

Ignjatović

2020

Colorectal Disease

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Aim The ileocolic vessels are important landmarks in advanced surgery of the midgut. The aim of the present study is to present variations of ileocolic vessels relevant to complete mesocolic excision with D3 lymphadenectomy of the right colon, within their detailed and precise morphometric framework and deriving from a large and consistent series of operated patients. Methods An ongoing prospective trial 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multidetector Computed Tomography Angiography' was reviewed. The imaging datasets underwent manual segmentation and 3D reconstruction, and the results were validated at surgery. A total of 356 patients were included in the study. Results A cross-section of the series revealed five cases (1.4%) with variation of ileocolic vessels relevant to complete mesocolic excision or D3 extended mesenterectomy. There were two cases with absence of a true classical ileocolic artery, two cases with absence of a true classical ileocolic vein, and one case of precocious bifurcation of the ileocolic artery, left to the superior mesenteric vein. The entire D3 area in all the cases was thoroughly documented and analysed from the morphometric point of view (calibres, lengths of vessels, crossing patterns). Conclusion The preoperative visualization of a patient's individual 3D anatomy is a powerful tool in identifying the variations whose negligence could have dire consequences in complete mesocolic excision of the right colon.

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“…Reconstruction of the pharyngoesophageal tract with bowel flaps has been described as a good and reliable method to restore the continuity of the aerodigestive tract. [1][2][3][4][5] However, when clinical factors such as a radiated field, contaminated recipient site or depleted recipient vessels are encountered, an alternative surgical approach is necessary. With any ischemic insult, bowel mucosa becomes very sensitive to prolonged absence of vascular supply or congestion, leading to epithelial damage, bacteria translocation, and possible failure of the conduit.…”

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confidence: 99%

Early Markers of Angiogenesis and Ischemia during Bowel Conduit Neovascularization

Manrique

Ciudad

Wong

et al. 2017

J reconstr Microsurg

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Background Bowel flaps are a good and reliable method to restore the continuity of the aerodigestive tract. Radiated fields, contaminated recipient sites, or depleted recipient vessels may increase the risk for ischemic injury after transfer. During ischemic events, we believe that bowel conduits with serosa have a delayed neovascularization process at its new recipient site.We conducted an ischemia/reperfusion murine model to understand the difference among bowel conduits with and without serosa. Materials and Methods Two groups of rats were compared: control group (jejunal conduit with serosa) and a target group (jejunal conduit without serosa). These conduits were harvested from the peritoneal cavity and transferred into a subcutaneous pocket. After 72 hours of transfer and pedicle ligation, histological changes related to ischemia/reperfusion were assessed. In addition, tissue markers of angiogenesis (CD34), ischemia (lactate dehydrogenase [LDH]), and inflammation (interleukin [IL]-1β and IL-6) were analyzed. Results Two groups (n = 20) of male rats were analyzed. Histology showed intact jejunal mucosa in the target group. The control group showed decreased number of mucin, globet cells, decreased height, and fragmentation of villi with the absence of intestinal glands. Markers of angiogenesis (CD34) were higher in the target group. In addition, markers of ischemia (LDH) (p = 0.0045) and inflammation (IL-1b, p = 0.0008, and IL-6, p = 0.0008) were significantly lower in the target group as compared with the control group. Conclusions In circumstances in which the recipient site does not offer an adequate and healthy bed or a vascular insult occurs, bowel flaps with less amount of serosa may be able to neovascularize faster thereby increasing its chances of survival.

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Absence of the ileocolic artery: Microsurgical implications in reconstruction of the esophagus with the free ileocolon flap

Cited by 4 publications

References 7 publications

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

Navigating the mesentery: Part III. Unusual anatomy of ileocolic vessels

Early Markers of Angiogenesis and Ischemia during Bowel Conduit Neovascularization

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