Voice reconstruction with free ileocolon flap transfer: implications for the lower respiratory tract.

Abstract:

BACKGROUND:Free ileocolon flap surgery is an effective technique for voice reconstruction in hypopharyngolaryngectomy defects. A tracheoesophageal fistula is created using an intestinal conduit characterized by secretions and a resident microbial flora. The aim of this study was to investigate the respiratory complications and modifications of the regional flora following ileocolon flap transfer. METHODS:A retrospective study was conducted on 35 patients who underwent voice reconstruction with the free ileocolon flap. The prevalence of respiratory symptoms, aspiration, and respiratory tract infections was studied and the management of respiratory complications was recorded. Ten patients were included in a cross-sectional study to evaluate the bacterial flora of the voice tube and the tracheostomy site. RESULTS:Six patients experienced aspiration of food into the trachea caused by incompetence of the ileocecal valve (n = 5) or pathologic tracheoesophageal fistula (n = 1). Four patients presented with pneumonia. In one case, pneumonia was consequent to aspiration caused by incompetence of the ileocecal valve. Radiotherapy, chemotherapy, and age older than 55 years did not influence the continence of the ileocecal valve. Mean follow-up was 34.2 months. Escherichia coli was the organism cultured most frequently. CONCLUSIONS:Reconstruction with the free ileocolon flap was shown to be a possible therapeutic option when considering the consequences on the lower respiratory tract. Aspiration was the main complication and was avoided by internal plication of the valve and by reduction of the ileocecal angle. Awareness of the nature of the bacterial flora colonizing the trachea and voice tube could be helpful in guiding the empirical antibiotic therapy in case of infection.

journal_name

Plast Reconstr Surg

authors

Rampazzo A,Gharb BB,di Spilimbergo SS,Chung KP,Chen HC

doi

10.1097/PRS.0b013e31820cf282

subject

Has Abstract

pub_date

2011-05-01 00:00:00

pages

1916-1924

issue

5

eissn

0032-1052

issn

1529-4242

pii

00006534-201105000-00020

journal_volume

127

pub_type

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