An effective pharyngoesophageal reconstruction with free radial forearm flaps

Byun, Jin‐Seok; Baik, Bong Soo; Park, J. S.

doi:10.1007/bf00660504

Cited by 7 publications

(13 citation statements)

References 13 publications

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“…e reported a pharyngoesophageal reconstructive method using a tubed free radial forearm flap in 1992. 9 In this paper, we include long-term follow-up in 23 patients who underwent pharyngoesophageal reconstruction using a tubed free radial forearm flap after resection of neoplasms between May, 1989 and October, 1995. Nineteen were males and four were females, with a 4.8: 1 male-to-female ratio.…”

Section: Patients and Methodsŵmentioning

confidence: 99%

“…We used the same technique described by Byun et al 9 with a radial forearm flap made into a tube to reconstruct the esophagus (Figs. 1-5).…”

Section: Patients and Methodsŵmentioning

confidence: 99%

“…Other authors have continued using the free radial forearm flap for pharyngoesophageal reconstruc- tion, and have decreased the complications commonly associated with the flap, such as high rates of fistula formation when used for circumferential defects and stricture formation at the lower anastomotic site, and have initially reported a modified method of free radial forearm flap reconstruction with a monitoring flap for checking flap survival. 9 We report 5 years of long-term follow-up in 23 patients who underwent a tubed free radial forearm flap for pharyngoesophageal reconstruction.…”

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confidence: 99%

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Pharyngoesophageal Reconstruction with a Tubed free Radial Forearm Flap

Cho

Kim²,

Lee³

et al. 1998

J reconstr Microsurg

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Various attempts at reconstruction of pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A tubed free radial forearm flap was used to reconstruct the pharyngoesophagus in 23 patients after resection of neoplasms from May 1989 to October 1995. Nineteen were males and four were females, the average patient age was 62.2 years. The follow-up ranged from 10 to 64 months (mean: 18 months). Oral intake within 3 weeks was possible in 18 patients (78 percent) The immediate postoperative complications were hematoma (n = 1), bleeding (n = 2), infection (n = 3), fistula (n = 4), and venous thrombosis (n = 1). A late complication was stricture of the lower anastomosing site (n = 3). The tubed free radial forearm flap has advantages over free jejunal transfer, including the larger caliber of the vascular pedicle, longer possible ischemic time, no laparotomy with less morbidity of the donor site, and better toleration of radiotherapy. Troublesome disadvantages include stricture and fistula formation at the suture sites. The authors modified the conventional free radial forearm flap to reduce complications. A small monitoring flap supplied by the septocutaneous branch of the radial artery was elevated to check the survival of the flap. During tubing, the vertical suture line was overlapped with a deepithelialized skin flap, and double layer sutures were done to prevent fistula. Two small triangular flaps were designed and inserted at the distal anastomotic site to prevent circular contracture. The outer-layer sutures were anchored to the surrounding rigid structure to withstand shrinkage and circular contraction. With this modification, the incidence of stricture and fistula formation was reduced to 13.0 percent and 17.4 percent, respectively, and these complications could be treated conservatively.

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Section: Patients and Methodsŵmentioning

confidence: 99%

“…We used the same technique described by Byun et al 9 with a radial forearm flap made into a tube to reconstruct the esophagus (Figs. 1-5).…”

Section: Patients and Methodsŵmentioning

confidence: 99%

mentioning

confidence: 99%

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Pharyngoesophageal Reconstruction with a Tubed free Radial Forearm Flap

Cho

Kim²,

Lee³

et al. 1998

J reconstr Microsurg

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“…6,7 The distal part of the radial artery gives many perforators to the cutaneous tissue, while the proximal part of the radial artery gives a few perforators. 2,8 Therefore, the distal part of the forearm skin has rich vascular networks. We designed a monitor flap near the wrist at the ulnar side of the distal part of the forearm.…”

Section: Surgical Techniquementioning

confidence: 99%

“…1 One of these flaps is the free radial forearm flap, recommended for patients in whom intraabdominal surgery has been contraindicated. 2 The qualities of an ideal monitoring technique are that it be objective, continuous, noninvasive, safe, easily managed and interpreted by the nursing staff, inexpensive, and a clear indicator of changes in the arterial and venous circulation. 1 The clinical assessment of tissue color, turgor, capillary refill, and bleeding is the most reliable method of monitoring viability of a flap, 1,3 but few reliable methods have been reported for monitoring the buried forearm flap.…”

mentioning

confidence: 99%

A New Flap Design for Monitoring the Circulation of a Buried Free Radial Forearm Flap in Pharyngoesophageal Reconstruction

Akın¹,

Basut²

2002

J reconstr Microsurg

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The viability of a free radial forearm flap which is used in pharyngoesophageal reconstruction is difficult to monitor because it is hidden by skin. As the most reliable method for monitoring, exteriorization of a small island flap has been reported. The authors used a skin paddle which is placed ulnar to the radial forearm reconstruction flap at the ulnar side of the distal part of the forearm as a monitor flap in one patient. Flap viability was assessed by observing tissue color, turgor, capillary refill, and bleeding of the monitor flap. This monitor flap is easy to elevate. The perfusion of the flap is good because it has a wide pedicle. It permits a long vascular pedicle for the radial forearm reconstruction flap and does not reduce available forearm skin for pharyngoesophageal reconstruction.

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