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J Reconstr Microsurg 2000; Volume 16(Number 5): 357-362
DOI: 10.1055/s-2000-7345
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

MICROSURGICAL RECONSTRUCTION FOR CAUSTIC INJURIES OF THE ORAL CAVITY AND ESOPHAGUS

Shigeru Ichioka, Takashi Nakatsuka, Yoshiyuki Minegishi, Hirotaka Asato, Tsuyoshi Takato, Kiyonori Harii
  • Department of Plastic and Reconstructive Surgery, Saitama Medical School, Saitama, and Departments of Plastic and Reconstructive Surgery and Oral Surgery, Faculty of Medicine, University of Tokyo, Japan
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Publication Date:
31 December 2000 (online)

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ABSTRACT

Ingestion of caustic material often produces profound and irreversible pathologic changes that require reconstructive surgery of the organs damaged. This report describes the authors' successful experience with microsurgical techniques that allowed adequate reconstruction in three patients with cicatricial contracture of the oral cavity and esophagus following ingestion of caustic substances.

All patients had attempted suicide by ingesting liquid alkali. Patients #1 and #2 complained of limited mouth opening and impaired tongue movement due to oral scar contracture. Contracture release in the first patient resulted in a defect from the anterior border of the mandible to the retromolar region. The defect was resurfaced with a 6 - 12 cm free forearm flap. Release of the scar contracture in the second patient resulted in a long, narrow, tortuous defect that was difficult to cover, even with a forearm flap, and a jejunal segment was microsurgically transferred as a patch graft to reconstruct the defect. Patient #3 had dysphagia due to stricture of the cervical portion of the esophagus. The defect after resection of the cervical portion was reconstructed by free jejunal interposition.

Appropriately selected free-flap transfer in each case provided a satisfactory restoration of function of the oropharyngeal and digestive passages.