ÜÇ FARKLI YÖNTEM İLE SERVİKAL ÖZAFAGUS DEFEKTLERİNİN ONARIMI

Yıl 2005, Cilt: 6 Sayı: 3, 37 - 41, 01.12.2005

Eray Copcu Alper Aktaş Nazan Sivrioğlu Serdar Şen Yücel Öztan

Öz

Servikal özafagus defektlerinin onarımı, rekonstrüktif cerrahinin en zor konularından biridir. Bu defektlerhipofarinks tümörleri ve primer servikal özafagus tümörleri sonucu gelişir. İdeal rekonstrüksiyon yönteminin,onkolojik cerrahi ile aynı seansta yapılabilir, erken fonksiyon sağlayabilir ve düşük morbidite oranına sahip birteknik olması gereklidir. Bu çalışmada üç farklı teknikle servikal özafagus onarımları, literatür bilgileriylebirlikte ayrıntılı olarak sunulmuştur. Olguların biri pektoralis major kas deri flebi, diğeri deltopektoral fleple veen son olgu da servikohumeral flep ve deri grefti ile rekonstrükte edilmiştir. Olguların tümünde oral alımı erkendönemde sağlanmıştır.Yutma fonksiyonun en erken zamanda sağlanmasının, yöntem seçiminde temel belirleyiciolduğunu düşünmekteyiz.Sonuç olarak bu çalışmada her ne kadar üç farklı yöntem, farklı cerrahların seçimi olarak sunulmuş ise de, buyöntemler kendi avantaj ve dezavantajlarına sahiptir. Deltopektoral flepde parsiyel nekroz gelişmesi,servikohumeral flebin ise geciktirme işlemine ihtiyaç duyması nedeniyle, sunulan yöntemler içinde pektoralismajor kas deri flebi ile onarım daha başarılı bunmuştur

Anahtar Kelimeler

ozafagus rekonstruksiyonu, pektoralis major muskulokutan flep, deltopektoral flep, servikohumoral flep

Reconstruction of Cervical Esophagus Defects With Three Different Techniques

Öz

Reconstruction of defects of the cervical esophagus is one of the most difficult tasks in reconstructive surgery. These defects are generally seen after tumors of hypopharynx and cervical esophagus. The method of reconstruction, which will be selected, therefore, must be reliable, a one-stage procedure with minimal morbidity and one that restores function in the shortest time possible. In this article, we present our experience with three different techniques: the pectoralis major musculocutaneous flap, the deltopectoral flap and a combination of cervicohumeral flap and skin grafting. Oral feeding was established early in all cases. We are of the opinion that the time for swallowing ability after operation is the one of the most important factors in determining the technique chosen for reconstruction of defects of the cervical esophagus. In conclusion, although three different techniques were presented in this study according to the surgeons choice, each technique has its own advantages and disadvantages. Since the partial necrosis in deltopectoral flap and necessity of the delay process in cervicohumeral flap were complications of the techniques, pectoralis major myo-cutaneous flap may be accepted as a more suitable reconstruction technique.

Anahtar Kelimeler

esophagus reconstruction, pectoralis major musculocutaneous flap, deltopectoral flap, cervicohumeral flap

Kaynakça

• 1. Chen H, Tang Y. Reconstruction of the esophageal defect. Seminars in Plast Surg 2003; 3:305-317
• 2. Surkin MI, Lawson W, Biller HF. Analysis of the methods of pharyngoesophageal reconstruction. Head Neck Surg 1984; 6:953
• 3. Stell PM, Missoten F, Singh SD, et al. Mortality after surgery for hypopharyngeal cancer. Br J Plast Surg 1983;70:713
• 4. Guillamondegui OM, Meoz R, Jesse RH. Surgical treatment of squamous cell carcinoma of the pharyngeal walls.Am J Surg 1978; 136:474
• 5. Wookey H. The surgical treatment of carcinoma of the pharynx and upper esophagus. Surg Gynecol Obstet 1942; 75;499
• 6. B a k amji a n VY. A tw o - st a g e m et h o d f o r pharyngoesophageal reconstrucrion with a primary pectoral skin flap. Plast Reconstr Surg 1965; 36:173
• 7. Ariyan S. The pectoralis major myocutaneous flap: a versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979; 63;73
• 8. Meyer R, Kelly TP, Failat ASA. Single bilobed flap for use in head and neck reconstruction. Ann Plast Surg 1981;6;203
• 9. Watson JS, Lendrum J. One stage pharyngeal reconstruction using a compound latissimus dorsi island flap. Br J Plast Surg 1981;34;87
• 10. Ariyan S. One-stage repair of a cervical esophagostome with two-myocutaneous flaps from the neck and shoulder. Plast Reconstr Surg 1979;63;426
• 11. Silver CE, Brauer RJ. Reconstruction of the cervical esophagus by visceral interposition. In Grabb's Encylopedia of flaps, 2nd ed. Strauch B, Vasconez LO and Hall-Findlay EJ (eds). Philadelphia: LippincottRaven. 1998: 4519
• 12. Seidenberg B, Rosenak SS, Hurwitt ES, Som MI. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959; 159;162.
• 13. Jones TR, Jones NF. Advances in reconstruction of the upper aerodigestive tract and cranial base with free tissue transfer. Clin Plast Surg 1992; 19:819.
• 14. Latifoğlu O, Ayhan S, Çelebi MC, Atabay K. Serbest jejunum flebi ile hipofarinks ve servikal özafagus rekonstruksiyonu. Türk Plastik Cerrahi Dergisi 1997; 5:1-6
• 15. Gilas T, Sako K, Razack MS, Bakamjian VY, Shedd DP, Calamel PM. Major head and neck reconstruction using the deltopectoral flap.A 20 year experience.Am J Surg 1986; 152:430-4.
• 16. Carlson GW, Coleman JJ 3rd, Jurkiewicz MJ. Reconstruction of the hypopharynx and cervical esophagus. Curr Probl Surg 1993; 30:427-72.
• 17. Byun JS, Baik BS, Park JS. An effective pharyngoesophageal reconstruction with free radial forearm flaps. Eur J Plast Surg 1992; 15:173
• 18. A n t h o n y J P, S i n g e r M I , M a t h e s S J . Pharyngoesophageal reconstruction using the tubed free radial forearm flap. Clin Plast Surg 1994;21:137
• 19. Schusterman MA, Shestak K, Swartz WM, et al. Reconstruction of the cervical esophagus: free jejunal transfer versus gastric pull-up. Plast Reconstr Surg 1990; 85:16
• 20. Chen YT, Chen H, Lee Y. Bakamjian island flap for patch esophagoplasty of cervical esophagus. Plast Reconstr Surg 1999; 103:1176