The appendix has a constant vascular anatomy and provides a small lumen that always maintains its patency because of mucosal secretion and motility; thus, it serves as an ideal conduit structurally. The appendix has been used in urologic surgeries as a pedicled flap and as a free flap in isolated case reports for the reconstruction of the urethra. However, this study proposes more extended applications of the appendix in different kinds of reconstruction.
From 2002 to 2011, 11 patients were included in this study retrospectively. Of these cases, 8 were transferred as free flaps, whereas the other 3 were pedicle flaps. Among the 8 free appendix transfers (Fig. 1A and B), 5 of them were used for voice reconstruction by creating a tracheoesophageal fistula; the other 3 were transferred to reconstruct the male urethra. Among the 3 pedicled appendix transfer, 2 were used for reconstruction of cervix and vagina, whereas the other was used for reconstruction of esophagus and voice tube simultaneously after ablation of cancers in the hypopharynx and esophagus.
All cases showed successful results not only structurally but also functionally. As for voice reconstruction, the appendix serves as an autologous fistula between the trachea and the esophagus with minimal complications and no aspirations. The intelligibility and loudness were fair to excellent, whereas fluency required persistent training and practice.
For patients who underwent urethral reconstruction, their micturition was smooth with ease postoperatively. Two of the patients also received penile reconstruction with fibula osteocutaneous flap simultaneously during the urethral reconstruction.
As for reconstruction of cervix and vagina, pedicled appendix-cecum-colon-complex is a great option offering long-term patency with an expandable diameter up to 2.5 cm.
Appendix has a reliable vascularity and a unique structure for reconstruction of conduit-like organs, and combining its adjacent bowel segments, including ileum, cecum, and colon, during tissue transfer not only increases its length but provides more applications and possibilities for reconstruction of different parts of the body. Removal of the appendix carries minimal morbidity. Our study proved the applicability and reliability of free and pedicled appendix transfer.