• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.99-105
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• 1996

The reconstruction of esophageal defect after ablative surgery have more difficult than other digestive tract tumor because the restoration of anatomical and physiologic function is difficult, the risk of tumor invasion into the adjacent tissue is large. The reconstruction of cervical esophus was depended on the degree of resection of the esophagus, various reconstruction method was developed to minimize functional deficiency and deformity of cervical region. Recently, the free jejunal transfer or free radial forearm flap was commonly utilized for esophageal reconstruction due to development of technique of the microvascular anastomosis. After the esophageal reconstruction used by free jejunal transfer was reported by Seidenberg in 1951, jejunum is most commonly used for reconstruction of esophgus. Becaue of, it have been tubed anatomical similarity with muscular layer, relative small risk of complication, possible of oral intake within 10 days after operation, and early rehabilitaion. Authors have been treated esophageal defect with free jejunal transfer in 7 patients after resection of lesion in 6 eshageal cancer and 1 esophageal stricture from December 1994 to January 1996. We were transferred jejunum used by intercostal artery as recipient artery in 3 cases, it was satisfied with results. If intercostal artery was utilized as recipient artery for free jejunal transfer, we believe that any site of intrathoracic or intraabdominal esophageal defect is possible to recontruction.

• Journal of Chest Surgery
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• 제34권11호
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• pp.843-847
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• 2001

배경: 식도질환의 수술 후 식도재건술은 아직도 식도수술에 관여하는 외과의사에게 해결해야 될 부분이 많이 있다. 1996년 1월부터 1999년 12월가지 흉부식도암환자 27명에서 흉부식도절제술 후 15예의 식도-위 문합술과 12예의 유리총장 이식술을 시행하였다. 저자들은 식도암 수술 후 문합부 누출, 문합부위의 협착, 역류성식도염, 수술시간, 호흡기 합병증 등을 양 군을 나누어 비교하였다. 대상 및 방법: 고식적 우회술 또는 식도인공삽입술, 인두식도와 식도 위 결합부위의 암은 본 연구에서 제외하였다. 우측 개흉술로 식도를 절제하였고, 자동봉합기를 사용하여 식도-위 문합을 시행하였다. 유리공장이식술의 경우 근위부의 식도는 6예에서 자동봉합기를 사용하였으며, 6예의 근위부와 12예의 원위부는 수기통합하였다. 모든 식도 재건술은 후종격동을 경유하였다. 결과: 3예의 수술사망을 포함하여 3예의 문합부 누출, 2예의 이식공장괴사 등 중한 합병증과 11예의 역류성 식도염, 5예의 문합부 협착이 발생되었다. 식도-위 문합술의 평균 수술시간은 300$\pm$160분, 유리공장이식술은 550$\pm$280분이었다. 결론: 역류성 식도염은 식도-위 문합군에서 더 많았고, 수술시간은 유리공장이식군에서 더 길었다(p<0.05). 적절한 환자의 선택과 장시간의 수술에 따르는 술 후 합병증을 줄일 수 있다면, 식도재건수술후의 역류식도염을 감소시키는 수술로 유리공장이식술이 우수하다고 판단된다.

• Journal of Chest Surgery
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• 제29권12호
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• pp.1392-1397
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• 1996

지난 2년동안 식도암 환자 6례, 식도협착 환자 1례에서 식도절제술후 유리공장 이식수술을 시행하였다. 환자들은 부분 식도절제술과 함께 기능적 경부청소술 또는 종격동 임파절 절개을 시행하였다. 유리공장이식술은 대개 경부식도 질환에서 경부혈관을 이용하여 시행되어 왔으나, 저자들은 늑간동정맥을 이용하여 3례 에서 공장이식을 하였다. 수술후유증은 이식괴사 1례, 문합부 누출 1례 였다. 유리공장이식술은7명의 환자중6명의 환자에서 성공하였가. 늑간동정 맥을 이용하면 흉부 식도 질환에서도 유리공장이식술을 할수 있으며, 5명의 환자는 현재 추적관찰 중이다.

• Journal of Chest Surgery
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• 제24권5호
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• pp.515-521
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• 1991

Since Carrel in 1907 reported transfer of a free jejunal segment in dog, reconstruction of the cervical esophagus and hypopharynx has been accomplished successfully with free jejunal transplantation using microvascular technique. Free jejunal graft is useful in cases of failed colonic interpositions. Three patients with benign esophageal stricture had undergone reconstruction with right colon interposition. Because of necrosis and stricture of the interposed colon, in each case the defect was reconstructed with a free jejunal graft by using microvascular technique. The postoperative course in two patients was uncomplicated, and they were able to eat general diet. Graft necrosis occurred in one patient, but she is waiting for a reoperation.

• 대한두개안면성형외과학회지
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• 제16권3호
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• pp.105-113
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• 2015

The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.245-248
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• 2006

Besides gastric pull-up or colonic interposition, microvascular technique in esophageal reconstruction has been approved reliable methods. When free intestinal transfer is considered, jejunal free flap is commonly used. We treated the patient who had undergone reconstruction with a right colon interposition and suffered from inability of swallowing because of stricture and necrosis of the interposed flap. Although we have planned jejunal free transfer, we couldn't use jejunum due to adhesion by previous gastrojejunostomy and colon interposition. Salvage procedure with microvascualr free left colon flap was executed successfully. After 9 month follow-up, the patient was able to consume a normal diet.

• 대한두경부종양학회지
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• 제16권1호
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• pp.26-32
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• 2000

Background and Objectives: Various flaps are using for reconstruction of hypopharyngeal and esophageal defect. However, complication and indication of each flap are not fully analyzed. Patient and Methods: Records of 52 hypopharyngeal cancer patients who had surgical treatment and 13 other head and neck cancer patients who underwent hypopharyngeal and/or esophageal reconstruction with flap were retrospectively analyzed. Eighty three percent(54 cases) of patients needed reconstruction other than primary pharyngeal closure. Five split thickness skin graft, 1 pectoralis major myocutaneous flap, 20 forearm free flap, 13 jejunal free flap, 15 gastric pull up were used. Result: Flap failure was noted in 2 cases who had subsequent gastric transposition. Wound dehiscence and fistula were most common problem of forearm free flap. Most fistulas were developed in patients with conduit type reconstruction of forearm flap while there wasn't any fistula in patient with patch type reconstruction. Stenosis of lower anastomosis was the frequent problem of jejunal transfer. Gastric pull-up has frequent com-plication of stomal stenosis. All but three patients had reached oral feeding postoperatively. Conclusion: Based on this study, forearm flap is effective in partial hypopharyngeal defect while jejunum is the choice for circumferential defect. Gastric pull-up is for combined esophageal defect.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1225-1230
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• 1992

Reconstructive surgical procedures for hypopharyngeal and cervical esophageal defects have still a lot of technical defficulties and varieties to be performed as a optimal treatment according to the clinical situation patient faced. We have experienced a case of successful reconstruction of cervical esophageal defect, which was resulted from graft failure of free jejunal transfer in 43 year old male with eso-phagocutaneous fistula, using free fasciocutaneous dorsalis pedis flap. This article describes the review of our case and literature relevant the reconstructive maneuvers of cervical esophageal defects.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.178-181
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• 2020

In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권2호
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• pp.113-121
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• 1994

Large oral defects following tumor resection pose formidable challenge for the reconstructive surgeon. Ideally, wound closure should utilize like tissue in providing expedient, single-stage closure, returning maximum function while minimizing deformity. Recent methods have reported and utilize variable mucocutaneous flaps. However, the ideal reconstruction has yet to defined. The small bowel serves as a readily available donor site for satisfying reconstructive needs in oropharyngeoesophageal defects. Segments of jejunum may be opened along the antimesenteric border and transferred to oral defect as free tissue transfers. Some of the benefits of this technique have included a one-stage procedure, abundant donor tissue with characteristics similar to oral mucosa, near normal facial appearance, preservation of maximum tongue function and relief of annoying xerostomia by jejunal mucous secretion. Three cases re presented in which two cases show successful use of this flap. The other one patient developed total necrosis of this flap. We report cases of reconstruction using free jejunal flap transfer in oral reconstruction.