Floor plan - 2013 Annual Meeting - American Association for Hand ...

Prevention of Distal End Pharyngoesophageal Stricture Using Z-pasty of Tubed Skin Flap and
Cervical Esophagus for Lower Anastomosed site
Institution where the work was prepared: Chang Gung Memorial Hospital- Kaohsiung Medical Center, Kaohsiung,
Taiwan
Yur-Ren Kuo, MD, PhD, FACS; Seng-Feng Jeng; Johnson Chia-Shen Yang; Chih-Yen Chien; Chih-Ying Su; Chang Gung
Memorial Hospital- Kaohsiung Medical Center, Chang Gung University
BACKGROUND:
Various attempts at reconstruction of pharyngo-esophageal defect after ablative cancer surgery have been made. Skin tubing flap was
the common used to reconstruct the defect. However, distal end circular contracture is a big complication. Herein, we presented a triangular-Z-pasty
suture technique to prevent distal end circular contracture.
MATERIALS/METHODS
Seven patients who had undergone esophagus reconstruction due to circumferential pharyngo-esophageal defect had been applied
this technique. All patients were stage III to IV. All patients were male. Their age ranged from 39 to 63 year-old with a mean of 51 yearold.
Four received free radial forearm flap and three received anterolateral thigh perforator flap. The distal end of tubed flap size was
designed at least 2 cm radius. The distal skin tube and cervical esophagus parts were incised at three lower tri-angular parts, respectively.
A Z- plasty triangular suture to increase the diameter of anastomosis site was designed. All patients received modality adjuvant
radiotherapy postoperatively. The follow-up ranged from 10 to 36 months.
RESULTS:
All the flaps were survived except one failed due to venous thrombosis. He redid another tubed radial forearm flap uneventfully. There
was no leakage in the cervical esophagus and tubed skin flap anastomosis junction. The barium swallowing study revealed a wide
patent anastomosis postoperatively without stricture after adjuvant radiotherapy. All patients tolerated regular diet smoothly after adjuvant
radiotherapy.
CONCLUSION:
With this modification, there is no apparent stricture in distal-anastomosis site of tubed skin flap. This is a useful technique to prevent
tubed contracture in pharygo-esophageal reconstruction.
Comparisons of Donor Site Morbidity Between Free Fibula Osteocutaneous Flap and
Osteomyocutaneous Peroneal Artery Perforator Flap
Institution where the work was prepared: Chang Gung Memorial Hospital, Taiyuan, Taiwan
Jing-Song Guo; Yu-Te Lin; Huang-Kai Kao; Jung-Ju Huang; Ming-Huei Cheng; Chang Gung Memorial Hospital
BACKGROUND:
Previously published studies have shown that there is only minimal donor site morbidity associated with free fibular osteocutaneous
flaps. A modification of the traditional free osteocutaneous fibula (fibula) flap, the osteomyocutaneous peroneal artery perforator (PAP)
flap includes a segment of soleus muscle to give it greater tissue volume. The PAP flap's versatility and extra volume makes it a good
flap for composite mandibular and maxillary reconstructions where there is great tissue loss. The purpose of this study is to compare
donor site morbidities between the PAP and o-fibula groups by performing functional soleus muscle evaluations.
MATERIALS/METHODS
Between December 1999 and May 2006, eight patients underwent PAP flap and thirteen patients underwent an fibula flap reconstructions
of either composite mandibular or maxillary defects at Chang Gung Memorial Hospital. Subjective evaluations were performed
by interviewing patients for donor leg symptoms, such as pain, paresthesia, problems walking, activity restrictions, gait alterations, and
donor site aesthetics. Objective assessments were performed by measuring ankle and big toe range of motion and power.
RESULTS:
The Mann-Whitney Test comparing the subjective questionnaire scores between the two study groups showed no significant differences
(p=0.447). The unpaired t-test comparing ankle and big toe range of motion in the PAP flap group and the fibula flap group also
showed no significant functional impairment from segmental soleus muscle harvesting (p>0.05). Muscle power evaluations also failed
to show any significant differences (p>0.05).However,either fibula or PAP flap dose compromise the donor leg ankle and big toe range
of motion comparing to normal leg(84.78% in fibula and 82.08% in PAP for ankle dorsiflexion as example).
CONCLUSION:
Although previous study claimed the donor site morbidity of fibula flap is minimal,the range of motion of ankle and big toe do decrease
after the surgery.Long-term follow up of PAP flap patients showed that donor site morbidity is similar to that of the fibula group. Due
to its greater flap volume, the PAP flap is a good reconstructive option for extensive mandibular or maxillary composite tissue which
might otherwise require double free-flaps.
212