|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
|In 1959, Seidenberg published the first description of reconstruction of the cervical esophagus and hypopharynx using the technique of revascularization of a jejunal segment by anastomosis of the small vessels of the bowel to vessels in the recipient neck.1 Since then, there has been extensive research into the technique of microsurgical transfer of flaps from different parts of the body, pioneered by the work of Drs. Buncke,2 Daniel and Taylor,3 and O'Brien.4 Several factors have contributed to the challenge of head and neck reconstruction using microsurgical technique:
1. The proximity of structures within the neck and the limited amount of local tissue available for reconstruction.
2. The size of the defect and the extension of tumor into surrounding structures.
3. The differences in philosophy of reconstruction between primary head and neck surgeons and reconstructive microsurgeons.5
Many techniques have been used to create a structure capable of allowing the passage of food and fluids in an attempt to maintain the anatomy and physiology of the upper digestive system. Surgeons who were primarily involved with thoracic and abdominal surgery have developed several techniques using abdominal tissue, particularly in the stomach, colon, and small bowel.6-11
Reconstructive surgeons and surgeons of the head and neck have tried to solve this challenge of reconstruction of the cervical esophagus and hypopharynx using surrounding tissue including local skin flaps, the tubular chest flap, and more recently, the myocutaneous flap. 12-21 Although multiple techniques using different tissues have been tried, the results in general have not been effective, and have been complicated by the frequent occurrence of salivary fistula, pharyngostomas, and esophagostoma. Attempts to rotate irradiated or normal local tissue into large postiesection defects have resulted in thoracic mutilation complicated by long recuperation and a poor quality of life. 22
In the period following the initial description by Siedenberg1 and up to the recent work by Gluckman et al.,23 the development of microsurgical techniques has brought about important changes in the head and neck reconstruction following tumor resection. Many new flaps and new donor sites have been suggested, with continued improvements in results achieved with microsurgical reconstruction. 27-30
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