Voice Reconstruction with Bowel Transfer

Hung-chi Chen; Samir Mardini

doi:10.1055/s-2004-815689

Seminars in Plastic Surgery, Inhaltsverzeichnis

Semin Plast Surg 2003; 17(3): 319-330
DOI: 10.1055/s-2004-815689

Voice Reconstruction with Bowel Transfer

Hung-chi Chen¹ , Samir Mardini²

¹Department of Plastic and Reconstructive Surgery, Chang Gung University Hospital, Taoyuan, Taiwan
²Department of Plastic Surgery, I-Shou University Hospital, Kaohsiung, Taiwan

Abstract

ABSTRACT

At this time, voice reconstruction with a voice prosthesis can achieve a fair result; however, this type of reconstruction has many drawbacks. Another direction in voice reconstruction has been the development of methods to restore voice using segments of bowel. This type of reconstruction, in which autogenous tissue, particularly bowel, is used to reconstruct a voice tube, continues to be a challenge. Even though techniques of microsurgical transfer of bowel for reconstructing the esophagus have become fairly routine, the use of these same methods for voice reconstruction poses a unique set of obstacles that are currently being overcome. Autogenous tissue such as jejunum, ileocolon, appendix, and skin flaps have all been applied to create voice tubes at the same time as esophageal reconstruction or as a separate procedure. Among these methods, jejunum and ileum are the most commonly used. Simultaneous reconstruction of the esophagus and voice tube using bowel segments has the following advantages: lack of complications that might be associated with the long-term use of voice prostheses, and improved function as compared with voice prostheses. In general, the jejunum provides the best deglutition function; however, it has a higher rate of food regurgitation into the airway when used to create a voice tube. At present, we prefer the use of an ileocolon flap for the reconstruction of both the esophagus and voice tube in one setting. Whereas using ileocolon might yield slightly inferior results with swallowing as compared with jejunum, results with voice function and prevention of regurgitation are superior. Although laryngeal allo-transplantation has potential applications, its use will be limited by the level of sophistication of immune-suppressant medication. Future trends in voice reconstruction might use a combination of both autogenous tissue and tissue engineered constructs to produce high-quality voice with little to no side effects.

KEYWORDS

Voice reconstruction - voice prosthesis - jejunum - ileocolon - appendix

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Referenzen

REFERENCES

1 Andrews J C, Mickel R A, Hanson D G, Monahan G P, Ward P H. Major complications following tracheoesophageal puncture for voice rehabilitation. Laryngoscope . 1987; 97(5) 562-567
2 Laccourreye O, Menard M, Crevier-Buchman L, Couloigner V, Brasnu D. In situ lifetime, causes for replacement, and complications of the Provox voice prosthesis. Laryngoscope . 1997; 107(4) 527-530
3 Singer M I, Blom E D. An Endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol . 1980; 89(6) 529-533
4 Brandenburg J H, Cragle S P, Rammage L A. A modified neoglottis procedure: update and analysis. Otolaryngol Head Neck Surg . 1991; 104(2) 175-181
5 Nakatsuka T, Harii K, Asato H, Ebihara S, Yoshizumi T, Saikawa M. Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience. Scand J Plast Reconstr Surg Hand Surg . 1998; 32(3) 307-310
6 Barlow T E. Variations in the blood-supply of the upper jejunum. Br J Surg . 1956; 174 473-475
7 Bradford C R, Esclamado R M, Carroll W R, Sullivan M R. Analysis of recurrence, complications, and functional results with free jejunal flaps. Head Neck . 1994; 16(2) 149-154
8 Khouri R K, Upton J, Shaw W W. Principles of flap prefabrication. Clin Plast Surg . 1992; 19 763-771
9 Chen H C, Tang Y B. Microsurgical reconstruction of the esophagus. Semin Surg Oncol . 2000; 19 235-245
10 Huang J L, Duan Z Q, Li-Yang, G uo, Sun Q, Li A F, Sun B Q. Esophageal reconstruction by jejunal transfer. Ann Plast Surg . 1999; 42 658-661
11 Chang T S, Wang W, Huang O L. One-stage reconstruction of esophageal defect by free transfer of jejunum: treatment and complications. Ann Plast Surg . 1985; 15(6) 492-496
12 Coleman III J J, Searles J M, Hester T R. et al . Ten years experience with the free jejunal autograft. Am J Surg . 1987; 154 394-398
13 Theile D R, Robinson D W, Theile D E, Coman W B. Free jejunal interposition reconstruction after pharyngolaryngectomy: 201 consecutive cases. Head Neck . 1995; 17(2) 83-88
14 Chang S Y, Chen H C, Tang Y B, Tan B K, Wei F C. Prefabrication of jejunum for challenging reconstruction of cervical esophagus. Plast Reconstr Surg . 1999; 104(7) 2112-2115
15 Carlson G W, Temple J R, Codner M A. Reconstruction of the pharynx and overlying soft tissue by a partitioned free jejunal flap. Plast Reconstr Surg . 1996; 97(2) 460-462
16 Ehrenberger K, Wicke W, Piza H, Roka R, Grasl M, Swoboda H. Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients. Arch Otorhinolarygol . 1985; 242(2) 217-223
17 Kinishi M, Amatsu M, Tahara S, Makino M. Primary tracheojejunal shunt operation for voice restoration following pharyngolaryngoesophagectomy. Ann Otol Rhinol Laryngol . 1991; 100(6) 435-438
18 Sisson G A, Goldman M E. Pseudoglottis procedure: Update and secondary reconstruction techniques. Laryngoscope . 1980; 90 1120-1129
19 Tanabe M, Honjo I, Isshiki N. Neoglottic reconstruction following total laryngectomy. Arch Otolaryngol . 1985; 111(1) 39-42
20 DeMeester T R, Johansson K, Franze I. et al . Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg . 1988; 208(4) 460-474
21 Nakatsuka T, Harii K, Ebihara S. et al . Free colon transfer: a versatile method for reconstruction of pharyngoesophageal defects with a large pharyngostoma. Ann Plast Surg . 1996; 37(6) 596-603
22 Chen H C, Kuo Y R, Hwang T L, Chen H H, Chang C H, Tang Y B. Microvascular prefabricated free skin flaps for esophageal reconstruction in difficult patients. Ann Thorac Surg . 1999; 67(4) 911-916
23 Deschler D G, Doherty E T, Reed C G, Anthony J P, Singer M I. Tracheoesophageal voice following tubed free radial forearm flap reconstruction of the neopharynx. Ann Otol Rhinol Laryngol . 1994; 103(12) 929-936
24 Cohen R C, Filler R M, Konuma K, Bahoric A, Kent G, Smith C. The successful reconstruction of thoracic tracheal defects with free periosteal grafts. J Pediatr Surg . 1985; 20(6) 852-858
25 Costantino P D, Nuss D W, Snyderman C H. et al . Experimental tracheal replacement using a revascularized jejunal autograft with an implantable Dacron mesh tube. Ann Otol Rhinol Laryngol . 1992; 101(10) 807-814
26 Delaere P R, Blondeel P N, Hermans R, Guelinckx P J, Feenstra L. Use of a composite fascial carrier for laryngotracheal reconstruction. Ann Otol Rhinol Laryngol . 1997; 106(3) 175-181
27 Donahue D M, Grillo H C, Wain J C, Wright C D, Mathisen D J. Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis. J Thorac Cardiovasc Surg . 1997; 114(6) 934-939
28 East C, Grant H, Jones B. Tracheal reconstruction using a composite microvascular temporoparietal fascia flap and nasal septal graft. J Laryngol Otol . 1992; 106(8) 741-743
29 Elliott M J, Haw M P, Jacobs J P, Bailey C M, Evans J N, Herberhold C. Tracheal reconstruction in children using cadaveric homograft trachea. Eur J Cardiothorac Surg . 1996; 10(9) 707-712
30 Froehlich P, Kearns D B, Seid A B, Pransky S M, Chappuis J P, Morgon A. One-stage tracheal reconstruction of congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol . 1996; 34(3) 245-252
31 Idriss F S, DeLeon S Y, Ilbawi M N, Gerson C R, Tucker G F, Holinger L. Tracheoplasty with pericardial patch for extensive tracheal stenosis in infants and children. J Thorac Cardiovasc Surg . 1984; 88(4) 527-536
32 Kamata S, Usui N, Ishikawa S. et al . Experience in tracheobronchial reconstruction with a costal cartilage graft for congenital tracheal stenosis. J Pediatr Surg . 1997; 32(1) 54-57
33 Khalil-Marzouk J F. Allograft replacement of the trachea. Experimental synchronous revascularization of composite thyrotracheal transplant. J Thorac Cardiovasc Surg . 1993; 105(2) 242-246
34 Watson J, Donald P J, Gourley I M, Pool R, Tyler W. Composite vasclarized free-rib and pleural transfer for laryngotracheal reconstruction. Otolaryngol Head Neck Surg . 1983; 91(4) 384-395
35 Yamada A, Harii K, Itoh Y, Kikawada T, Miyashita H. Reconstruction of the cervical trachea with a free forearm flap. Br J Plast Surg . 1993; 46(1) 32-35
36 Chen H C, Chana J S. Use of the free jejunal flap to reconstruct a diversionary conduit for swallowing resolves recurrent choking following pharyngoesophageal injury. Plast Reconstr Surg . 2003; 112(6) 1528-1533
37 Rose K G, Sesterhenn K, Wustrow F. Tracheal allotransplantation in man. Lancet . 1979; 1(8113) 433