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Life after Intentional Corrosive Ingestion: Combining Esophageal Reconstruction with Aesthetic Procedures

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

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 448e-449e
doi: 10.1097/PRS.0b013e3181bcf267
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Department of Plastic Surgery, E-Da Hospital/I-Shou University, Yan-Chau Shiang, Kaohsiung County, Taiwan, Republic of China (Chen, di Spilimbergo)

Department of Plastic Surgery, University Hospitals Cleveland, Case Western Reserve University, Cleveland, Ohio (Salgado)

Division of Plastic Surgery, Mayo Clinic, Rochester, Minn. (Mardini)

Department of Plastic Surgery, E-Da Hospital/I-Shou University, Yan-Chau Shiang, Kaohsiung County, Taiwan, Republic of China (Gharb)

Correspondence to Dr. Chen, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-shu Tsuen, Yan-Chau Shiang, Kaohsiung County, Taiwan 824, Republic of China, ed100002@edah.org.tw

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Sir:

In Asian countries, a variety of corrosive substances are routinely used to soften rice before cooking and are therefore found in many kitchens.1 Suicide attempts involving the ingestion of these agents are undertaken because of psychological crises. In addition to the necessary esophageal reconstruction, intensive psychological treatment immediately following the injury is of utmost importance and must be carried through to the point where the patients are well equilibrated back into their environment. After accomplishing the reconstruction with techniques reported previously,2–4 these patients have body image issues that are more severe than they were before the attempted suicide.

We have offered aesthetic procedures in an effort to improve their quality of life for a select group of patients who have recovered from such episodes. Between December of 2005 and May of 2006, three esophageal reconstruction patients underwent aesthetic procedures in an effort to improve their quality of life. Within 12 months after reconstruction, a combination of revision of facial and abdominal scars, bilateral upper blepharoplasty with creation of supratarsal folds, and a rhytidectomy was performed on all patients. The face lift involved elevation of skin flaps in the face through preauricular and postauricular incisions and a 4-cm submental incision. Dissection of the skin flaps in the neck is performed with caution to avoid injuring the bowel graft that is placed in the standard fashion for diversion loop procedures. A nasogastric tube was placed in all patients and used for feeding the patients for 5 days. Because of the concern for injury to the neoesophagus, the patients were given nothing by mouth for the first 5 days after surgery and then underwent esophagography to detect minor leaks that could have occurred during dissection of the neck skin. The cost of the blepharoplasties and face lifts was covered by a grant from the institution that provided funding for this study. Scar revisions were covered by the patients' health insurance.

An appearance-related quality-of-life questionnaire (Derriford Appearance Scale-24) was administered preoperatively and postoperatively to quantify patients' disfigurement caused by corrosive injury and subsequent esophageal reconstruction, and to assess improvements following aesthetic procedures. There were no complications related to the aesthetic procedures. One patient required rerevision of a scar in the neck because of recurrent scar contracture. All patients were satisfied with the surgical outcomes and felt that these procedures provided some enhancement to the quality of their lives (Figs. 1 and 2). All patients also demonstrated an improvement in their Derriford Appearance Scale-24 score postoperatively.

Fig. 1.

Fig. 1.

Fig. 2.

Fig. 2.

In conclusion, esophageal reconstruction following corrosive injury has a tremendous impact on the patient's quality of life. The addition of aesthetic procedures in a select group of patients enhances the patient's body self-confidence. The patients must be selected carefully and approached only if they ask for improvement in aesthetic outcomes (scars or issues), which should be discussed only after several months of getting to know the patient, and with adequate psychological counseling and completion of a successful esophageal reconstruction.

Hung-Chi Chen, M.D.

Stefano Spanio di Spilimbergo, M.D.

Department of Plastic Surgery

E-Da Hospital/I-Shou University

Yan-Chau Shiang, Kaohsiung County

Taiwan, Republic of China

Christopher John Salgado, M.D.

Department of Plastic Surgery

University Hospitals Cleveland

Case Western Reserve University

Cleveland, Ohio

Samir Mardini, M.D.

Division of Plastic Surgery

Mayo Clinic

Rochester, Minn.

Bahar Bassiri Gharb, M.D.

Department of Plastic Surgery

E-Da Hospital/I-Shou University

Yan-Chau Shiang, Kaohsiung County

Taiwan, Republic of China

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DISCLOSURE

None of the authors has any commercial associations that might pose or create a conflict of interest with the information presented in this article.

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REFERENCES

1.Lai KH, Huang BS, Huang MH, et al. Emergency surgical intervention for severe corrosive injuries of the upper digestive tract. Zhonghua Yi Xue Za Zhi (Taipei) 1995;56: 40–46.
2.Chen HC, Tang YB, Noordhoff MS. Reconstruction of the entire esophagus with “chain flaps” in a case of complicated corrosive injury. Plast Reconstr Surg. 1989;84:980– 984.
3.Chen HC, Chana JS, Chang CH, et al. A new method of subcutaneous placement of free jejunal flaps to reconstruct a diversionary conduit for swallowing in complicated pharyngoesophageal injury. Plast Reconstr Surg. 2003;112:1528–1533.
4.Chen HC, Tang YB. Microsurgical reconstruction of the esophagus. Semin Surg Oncol. 2000;19:235–245.

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