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Pharyngoesophageal Reconstruction

  • Chung-Kan Tsao
  • Dalia Tobbia
Chapter
Part of the Head and Neck Cancer Clinics book series (HNCC)

Abstract

Pharyngoesophageal reconstruction is a complex undertaking requiring meticulous skillfulness with a diverse set of reconstructive considerations and a multidisciplinary coordinated effort. The aim of esophageal reconstruction would be a single-stage procedure to restore its function as a physiologic conduit and achieve early oral realignment with minimal complications. Esophageal replacement options after resection depend not only on the length and anatomic location of the resultant defect but also the nature of the defect, namely, whether it involves the full circumference or partial wall of the esophagus. This detail has an effect on the type of flap chosen. The choice of flap depends on individual surgeon’s expertise and preference. Since the application of microsurgery, almost all kinds of esophageal defects can be reconstructed successfully. Free jejunal flap is very useful for reestablishing the mucosal conduit of the upper digestive tract, especially the cervical esophageal defect caused by tumor extirpation surgery. Free tubed skin flaps such as radial or ulnar forearm flaps, anterolateral thigh flap, or lateral thigh flaps can be used in full-circumference defects as an alternative to intestinal interposition conduits. For complete rehabilitation, restoration of both swallowing and phonation is required despite the low life expectancy in this patient group. It is possible to restore voice production by any kind of surgical voice reconstruction. Pedicled ileocolic flap with additional supercharge to ensure adequate proximal circulation is the author’s preferred method for long-segment esophageal reconstruction. The reconstruction of pharyngoesophageal defects can be achieved by a range of reconstructive techniques.

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Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Chung-Kan Tsao
    • 1
  • Dalia Tobbia
    • 1
  1. 1.Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, College of Medicine, Chang Gung UniversityTaoyuanTaiwan

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