Reconstruction of the pharynx and cervical esophagus using ileocolic free autograft

Voice Reconstruction with Free Ileocolon Flap Transfer: Implications for the Lower Respiratory Tract

“…Since 1995, we have performed 78 free ileocolic flaps for reconstruction of voice and swallowing in patients undergoing hypopharyngolaryngectomy. Our 4 and other groups' 5,8,9 clinical experience showed that the procedure is reliable in achieving an intelligible voice with low donor-site morbidity. However, the prevalence of the respiratory complications related to the tracheoesophageal shunt and risks associated with an intestinal conduit producing secretions with a high bacterial count at the inlet of the tracheostomy were not addressed in the previous reports.…”

Voice and Swallowing After Laryngopharyngectomy and Free Ileocolic Flap Reconstruction for Hypopharyngeal Cancer

“…When closed, the ileocecal valve protects against aspiration and, when open, permits the passage of air to allow phonation. 9,15,16 One disadvantage of the ileocolic flap is the bowel haustrations, in contrast to the straight, smooth inner surface of the esophagus. The haustral folds of the transferred colon may cause pooling of saliva and stasis of food, delaying its delivery to the distal esophagus (Fig.…”

“…2). 15 We addressed this problem by maintaining tension on the transferred colon, thus decreasing the effect of the haustrations and promoting more rapid food passage. Phonation is provided by this flap by allowing expiratory air from the trachea to pass through the terminal ileum and the ileocecal valve into the cecum or pharynx (Fig.…”

“…4). 9,15,16 The ileocecal valve is in fact not a true valve; it is merely a sphincter that is normally under autonomic control in the abdomen. This sphincter function may lose after denervation and transfer of the flap, allowing regurgitation of ingested food.…”

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

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The free ileocolon flap, described by Kawahara et al in 1992, 1 is now a popular option in esophageal reconstruction, One of the main advantages of this flap is its consistent anatomy, which enables a large segment of ileo-colon to be harvested, based on the ileocolic artery (ICA) and vein. 2 We recently used the free ileocolon flap for a case of reconstruction of the cervical esophagus. During flap harvest, it appeared that the ileocolon segment was nourished by two distinct arterial branches (ileal and colic), both running in close proximity and originating directly from the superior mesenteric artery (SMA).

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