J Reconstr Microsurg 2021; 37(06): 475-485
DOI: 10.1055/s-0040-1719046
Original Article

The Benefits of the Supercharged Ileocolic Flap in Patients Who Underwent Total Esophagectomy and Gastrectomy

1  Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
2  Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
3  Department of Otorhinolaryngology, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
,
Shih Ching Kang
4  Department of Trauma and Emergency Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
,
David Chon Fok Cheong
2  Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
,
Shao Yu Hung
2  Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
,
Szu Han Wang
2  Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
,
Ting Han Chiu
2  Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
,
Yu Ting Chen
2  Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
,
Chung Kan Tsao
2  Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
5  Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
› Author Affiliations

Abstract

Background Patients who undergo total esophagectomy and gastrectomy present a challenging scenario for reconstructive surgeons. Several techniques have been described. However, the best choice is still a matter of debate. We aim to report our experience with the supercharged ileocolic flap, then to compare the long-term functional outcomes in cancer and caustic injury patients. We investigate the safest route of transposition and demonstrate the importance of supercharging the flap. Last, we perform a literature review to compare our results with the ones reported in the literature.

Methods A total of 36 patients underwent the supercharged ileocolic flap procedure. The details reviewed included the type of defect, flap characteristic, route of transposition, complications, patient survival, and swallowing evaluation. Survival and long-term function preservation were considered as the main outcomes. A secondary end-point was the identification of the safest route of transposition. We extracted the pertinent literature on supercharged bowel flaps from 1995 to July 2020

Results All flaps survived; only two flaps were partially lost. Thirty-three percent of the cohort experienced postoperative complications; the most common was leakage of the cervical anastomosis (17%), followed by neck wound infection (8%). The 5-year dysphagia-free survival rate was 87% in corrosive injury patients and 78% in cancer patients. The mean time to be free from dysphagia after surgery was 25.12 ± 4.55 months for corrosive patients and 39.56 ± 9.45 months for cancer patients (p = 0.118). The safest route of transposition was retrosternal extra-mediastinal. From the literature review, the data from 11 studies were extracted.

Conclusion The supercharged ileocolic flap is a robust option for total esophageal replacement when the stomach is not available and the retrosternal route is the safest for transposition. The functional outcomes are excellent, with acceptable morbidity and a good life expectancy, either in cancer and noncancer patients. Supercharging the flap is recommended.



Publication History

Received: 22 May 2020

Accepted: 20 September 2020

Publication Date:
17 November 2020 (online)

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