Histological Changes of the Voice Tube and Possible Clinical Consequences After Voice Reconstruction With Free Ileocolon Flap

Abstract

Free ileocolon flap has become a valid option for restoration of speech after pharyngolaryngectomy. After transfer, deprivation of the trophic intestinal contents and exposure to chronic intermittent airflow could substantially modify the structure of the voice tube, compromising its function. Biopsy specimens from 14 voice tube segments were examined. Sections were evaluated after staining with hematoxylin-eosin, trichromic Masson, and antiproliferating cell nuclear antigen. In all samples, the mucosa displayed diffuse atrophy and decreased proliferation rate, and in some areas only a single layer of goblet cells and enterocytes was present. Erosions, ulcerations, and dysplastic changes were absent and the alterations were limited to the mucosal layer. None of the patients experienced problems related to the modifications of the mucosa. The changes detected in the voice tube mucosa seem to indicate a physiologic adaptation to the new environment as proved by disappearance of the chronic inflammatory infiltrate and absence of erosions when the steady state was reached.

Thirty‐five years of single surgeon experience in the reconstruction of esophagus and voice with free ileocolon flap following total pharyngolaryngectomy

“…For these reasons, rapid autolysis is initiated soon after the onset of ischemia. Microstructural changes are noted even within 30 min of ischemia . If the ischemia time is too long, the bowel segment will not survive even after optimal microvascular anastomoses.…”

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

“…Fifteen studies reported the use of postoperative chemotherapy or radiotherapy (►Table 3). 12,13,15,[17][18][19][20][24][25][26][27][28][29]33,[35][36][37][38][39] Primary and secondary reconstructions were performed in 24.6 (n ¼ 134) and in 19.1% (n ¼ 104) of the cases, respectively (►Table 4). The surgical time ranged from 8 to 14.5 hours reported in four studies.…”

Early Markers of Angiogenesis and Ischemia during Bowel Conduit Neovascularization

“…5 In the last decade, our group has conducted a significant number of aerodigestive track reconstructions using free and pedicle bowel flaps. 8,12,13,[18][19][20] Even though the success rate of these flaps is high, 6 we have noticed that when a ischemic event occurs, the portion of the bowel conduit that survives is usually the one not covered by serosa (e.g., posterior wall of the terminal ileum and ascending colon). However, and up to now, no study has demonstrated this physiological process among bowel conduits with and without serosa during ischemic events.…”

“…Free tissue transfer based on bowel conduits for pharyngolaryngectomy reconstruction has been used for many years with very promising outcomes. 10,14,15,19 From the clinical standpoint and based on many years of clinical observation by the senior author, 3,5,8,11,12,18,19 the physiological response of some of these bowel conduits during ischemic events is different. The lack of serosa in the posterior aspect of the ileum and colon compared with an intact serosal layer throughout the circumference of the jejunum is a possible hypothesis for the difference in behavior of these conduits during a period of ischemic/reperfusion injury.…”

“…One of the main anatomical differences between some common flaps used to reconstruct the aerodigestive track, such as the jejunum or the ileocolon flaps, is the lack of serosa in the posterior wall of the ileum and colon. 8,9 Based on our clinical experience, we hypothesize that the serosa may delay the neovascularization process after the bowel conduit has been transferred to its recipient site.…”