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Donor-Site Morbidity after Free Ileocolon Flap Transfer for Esophageal and Voice Reconstruction

Rampazzo, Antonio M.D.; Salgado, Christopher J. M.D.; Gharb, Bahar Bassiri M.D.; Mardini, Samir M.D.; di Spilimbergo, Stefano Spanio M.D.; Chen, Hung-Chi M.D.

Plastic and Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - p 186e-194e
doi: 10.1097/PRS.0b013e31818cc11e
Reconstructive: Head and Neck: Original Articles

Background: Radical excision of advanced hypopharyngeal and laryngeal tumors usually compromises both swallowing and speech. Among the available reconstruction methods, the free ileocolon flap allows rehabilitation of both functions in one stage. The donor-site morbidity of this flap has not been addressed in head and neck cancer patients.

Methods: A retrospective study was conducted in 34 patients between April of 2003 and December of 2007 to investigate donor-site morbidity in patients undergoing reconstruction with free ileocolon flaps. Complications such as diarrhea, upper gastrointestinal tract distress, bowel leak, abscess, or hernia formation were evaluated. Significant association of diarrhea and upper gastrointestinal distress, previous abdominal operations, systemic diseases, primary versus secondary reconstruction, flap length, and postoperative chemotherapy were subsequently evaluated. Differences were considered significant for values of p ≤ 0.05.

Results: There were no perioperative or postoperative deaths. Nineteen patients (56 percent) experienced temporary diarrhea. In all but two patients, diarrhea discontinued by 4 months. Chemotherapy was significantly associated with diarrhea (p < 0.01). Colchicine, terbinafine, and heroin withdrawal episodically caused diarrhea but statistical conclusions could not be drawn. Six patients (18 percent) suffered from upper gastrointestinal tract problems (gastroduodenal ulcer, erosive gastritis, and minor bleeding), probably because of insufficient gastric protection.

Conclusions: The free ileocolon flap proved to be a reliable method when simultaneous restoration of swallowing and speech was required, with donor-site morbidity comparable to that of the other intestinal flaps.

Taiwan, Republic of China; Cleveland, Ohio; and Rochester, Minn.

From the Department of Plastic Surgery, E-Da Hospital, I-Shou University, the Department of Plastic Surgery, University Hospitals Cleveland, Case Western Reserve University, and the Division of Plastic Surgery, Mayo Clinic.

Received for publication April 15, 2008; accepted June 30, 2008.

Hung-Chi Chen, M.D., E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-shu Tsuen, Yan-Chau Shiang, Kaohsiung County, Taiwan 824, Republic of China,

Disclosures: None of the authors has any commercial associations that might pose or create a conflict of interest with the information presented in this article. This includes consultancies, stock ownership or other equity interests, patent licensing arrangements, and payments for conducting or publicizing the study described in the article.

©2008American Society of Plastic Surgeons