Immediate Reconstruction of the Cervical Esophagus by a Revascularized Isolated Jejunal Segment

ÖZAmaç: Bu çalışmada majör baş-boyun cerrahisi sonrası, kulak burun boğaz uzmanlarınca mikrovasküler serbest doku flebi ile rekonstrüksiyon yapılan hastalarda flep başarı oranları ve hasta morbiditesi araştırıldı. ABSTRACT Objectives:This study aims to assess the success rate of surgery and postoperative morbidity in patients who underwent major head and neck surgery with reconstruction by microvascular free flaps performed by otolaryngologists. Patients and Methods:We retrospectively analyzed the medical records of 63 patients (31 males, 32 females; mean age 47.9±12.5 years; range 20-71 years) operated in our clinic between September 2012 -August 2016. The indications of reconstruction by free flap, success rates, need for revision and re-exploration, reasons of flap failure, morbidity and mortality were evaluated.Results: Thirty-seven (56.9%) of the 65 microvascular free flaps were radial forearm; 23 flaps (35.4%) were fibula and five flaps (7.7%) were rectus abdominis. Three of the total 65 flaps ended up in failure; accordingly the success rate was 95.4%. Except for these three failure cases, an urgent re-exploration was performed on 13 patients in the first postoperative 48 hours (n=16, %24.6). No permanent major sequel was observed in any of the patients. Conclusion:From the otolaryngologists' point of view, we observed that performing microvascular surgery and the successful surgical results not only gives the flexibility in reconstruction but also provides safer resection during ablative surgery.

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“…[5] 1975 yılında Taylor ve ark. [6] uzun kemik travmalarında vaskülarize fibula, 1980 yılında Pennington ve ark.…”

Section: Discussionunclassified

The use of microvascular free flaps in head and neck reconstruction performed by the otorhinolaryngologists: a series of 65 flaps

Başaran

Ünsaler²,

Aslan³

2016

Kulak Burun Bogaz Ihtis Derg

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“…The donor vessels can be anastomosed to the superior thyroid artery and the anterior facial vein. This technique was shown to be possible in experimental dogs before it was attempted in patients (Seidenberg et al, 1959;Hopkins & Bernatz, 1963).…”

Section: General and Vascular Surgerymentioning

confidence: 99%

Microsurgery in the clinic and laboratory

Green

1987

Lab Anim

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Laboratory animals have been crucial to the development of modern microsurgical techniques which are now routinely used in many clinical departments worldwide. In return, microsurgical techniques are important in biomedical research as they allow many surgical procedures to be performed on rodents instead of dogs, pigs or primates. This has obvious advantages in terms of low cost, the use of statistically valid numbers for comparison and the availability of genetically defined animals which are more likely to give valid answers to immunological questions. Microsurgical reconstruction is important in plastic, orthopaedic, urogenital, vascular and peripheral nerve surgery in man and it is likely that it will become part of every surgeon's training in the near future. In this review, the instrumentation essential to any microsurgical enterprise and the sutures available are described. Basic microsurgical techniques for end-to-end and end-to-side anastomosis of small vessels and for joining peripheral nerves, oviducts and other tubular structures are given in outline. Techniques for transplanting kidney, heart, heart and lung, liver, spleen, pancreas, small bowel, stomach, testicle, ovary and whole joint are only outlined but key references are given. Finally, some of the clinical indications for microsurgical reconstruction are reviewed.

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“…The jejunal flap was first described in 1957, and has been used for reconstruction of the pharynx and esophagus. During the transfer, an isolated segment of jejunum is removed from the abdomen and transferred to the neck 7 . In the clinical setting, I/R injury can be seen ten minutes after reperfusion, with gradual recovery until the 28th day 8 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Antioxidantes enterais em lesões de isquemia e reperfusão em ratos

Köhler

Delucca

Neto

2011

Rev. Col. Bras. Cir.

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Enteral antioxidants in ischemia/reperfusion injuries in rats Enteral antioxidants in ischemia/reperfusion injuries in rats Enteral antioxidants in ischemia/reperfusion injuries in rats Enteral antioxidants in ischemia/reperfusion injuries in rats Enteral antioxidants in ischemia/reperfusion injuries in rats Antioxidantes enterais em lesões de isquemia e reperfusão em ratos Antioxidantes enterais em lesões de isquemia e reperfusão em ratos Antioxidantes enterais em lesões de isquemia e reperfusão em ratos Antioxidantes enterais em lesões de isquemia e reperfusão em ratos Antioxidantes enterais em lesões de isquemia e reperfusão em ratos HUGO Methods Methods Methods Methods: Ninety adult male Wistar rats were used. An intestinal segment was isolated based on its vascular pedicle. A control biopsy was performed and the pedicle was sectioned and sutured again, ensuring a time of 60 minutes of ischemia followed by reperfusion. Sequential biopsies were performed at the end of the ischemic period and every 15 minutes during reperfusion. The treatment consisted of saline, vitamin C, vitamin E or a combination of the latter two. Quantitative and qualitative assessments of the biopsies were performed. Results Results ResultsResults Results: The groups treated with vitamin E alone or vitamin E combined with vitamin C showed a statistically significant attenuation of ischemia-reperfusion, with reduced loss of height of the villi and lower neutrophilic infiltration at the end of the study when compared to the control and vitamin C- INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTIONT he restoration of blood flow to an ischemic tissue can lead to greater harm than that originally caused by ischemia. This event is called ischemia and reperfusion (I/R) injury. The small intestine is particularly susceptible to injury from I/R 1 and its occurrence is associated with high morbidity and mortality 2 . Although the mechanisms involved are not fully elucidated, it is believed that oxidative stress mediators, such as reactive oxygen species (ROS), polymorphonuclear neutrophils (PMN) and nitric oxide (NO) play an important role 3 . Due to the involvement of ROS in I/R injury, various antioxidants have been tested, among them vitamin C (ascorbic acid) and vitamin E. Ascorbic acid is an water-soluble antioxidant with chelating and reducing properties and it is used to prevent I/R injury 4 . Vitamin E (á-tocopherol) is a nonenzymatic, lipid soluble antioxidant that acts against oxidative stress by stabilizing membrane unsaturated fatty acids. Thus, tissues treated with vitamin E have an increased capacity to reduce ROS and be protected against membrane lipid peroxidation 5 . Vitamins C and E can act synergistically because ascorbic acid is unable to reduce the peroxyl radical, but it can regenerate á-tocopherol from the tocoferoxil radical, recycling the á-tocopherol 6 . I/R can occur in a variety of clinical situations, one being the microsurgical transfer of jejunal segments. The jejunal flap was first described in 1957...

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Immediate Reconstruction of the Cervical Esophagus by a Revascularized Isolated Jejunal Segment

Cited by 563 publications

References 4 publications

The use of microvascular free flaps in head and neck reconstruction performed by the otorhinolaryngologists: a series of 65 flaps

The use of microvascular free flaps in head and neck reconstruction performed by the otorhinolaryngologists: a series of 65 flaps

Microsurgery in the clinic and laboratory

Antioxidantes enterais em lesões de isquemia e reperfusão em ratos

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