Microvascular prefabricated free skin flaps for esophageal reconstruction in difficult patients Hung-chi Chen, Yur-ren Kuo, MD, Tsann-long Hwang, Hern-hsin.

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Presentation transcript:

Microvascular prefabricated free skin flaps for esophageal reconstruction in difficult patients Hung-chi Chen, Yur-ren Kuo, MD, Tsann-long Hwang, Hern-hsin Chen, MD, Chau-hsiung Chang, Yueh-bih Tang, MD, PhD The Annals of Thoracic Surgery Volume 67, Issue 4, Pages 911-916 (April 1999) DOI: 10.1016/S0003-4975(99)00152-6

Fig 1 (A) The diagram shows the vascular pedicle, and regular dimensions of the tensor fascia lata flap. (A = anterior superior iliac spine; B = lateral condyle of tibia; 1 = ascending branch of the lateral femoral circumflex artery; 2 = transverse branch; 3 = descending branch.) (B) The diagram shows the vascular pedicle and dimensions of the radial forearm flap. (BA = brachial artery; RA = radial artery.) The Annals of Thoracic Surgery 1999 67, 911-916DOI: (10.1016/S0003-4975(99)00152-6)

Fig 2 (A) Prefabrication for the tensor fascia lata flap. A flap (40 by 10 cm) is required to obtain reliable viability of the extended length. It also ensures healing of the long suture line before transfer. The flap was partially raised. The skin was inverted to become the inner lining of the esophagus. After healing of the long suture line, this flap would not be affected by saliva and intestinal juices. Note the long suture line. (AB = the length of the tensor fascia lata flap; BC = the extended length of the flap when a delay procedure is performed.) The pedicle artery was the transverse branch of the lateral femoral circumflex artery. (B) Method of tubing the flap to ensure healing of the suture line. Two-layered sutures were performed. (AB = the shaded area is the zone that was still attached to the thigh; 1 = the first layer of skin suture; 2 = the second layer suture through the fascia.) Two weeks later the flap was raised completely and transferred to reconstruct the esophagus. The recipient artery was the right thoracoacromial artery and the recipient vein was its concomitant vein. The upper end of the prefabricated skin tube was joined to the cervical esophagus. The lower end of the skin tube was anastomosed with jejunum. (C) Esophagogram showing the smooth passage of the contrast medium at 2 years of follow-up. The Annals of Thoracic Surgery 1999 67, 911-916DOI: (10.1016/S0003-4975(99)00152-6)