Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(03): 378-396
DOI: 10.1055/s-0042-1748652
Pediatric/Craniomaxillofacial/Head & Neck
Review Article

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

Joseph M. Escandón
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Eric Santamaría
2   Department of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Cancer Institute, Mexico City, Mexico
,
Peter A. Prieto
3   Surgery Department, University of Rochester Medical Center, New York; Wilmot Cancer Institute, University of Rochester Medical Center, New York
,
Daniela Duarte-Bateman
4   Division of Plastic and Reconstructive Surgery, Cleveland Clinic, Ohio
,
Pedro Ciudad
5   Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
6   Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
,
Megan Pencek
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Howard N. Langstein
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Hung-Chi Chen
6   Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
,
Oscar J. Manrique
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

Keywords

ileum - colon - hypopharyngeal neoplasms - reconstructive surgical procedures - free tissue flaps - laryngectomy

Ethical Approval

Statement of Institutional Review Board Approval and/or Statement of Conforming to the Declaration of Helsinki: The present manuscript did not require Institutional Review Board approval.


Author Contributions

Conceptualization: J.M.E. and O.J.M. Data curation: J.M.E. and D.D.-B. Formal Analysis: J.M.E. and O.J.M. Funding Acquisition: J.M.E. Investigation: J.M.E. and D.D.B. Methodology: J.M.E. and O.J.M. Project administration: O.J.M. and H.C.C. Resources: O.J.M. Software: J.M.E. Supervision: O.J.M., H.-C.C, P.C. Validation: All authors; Visualization: All authors; Writing-original draft: All authors; Writing-review and editing: All authors.


Supplementary Material



Publication History

Article published online:
27 May 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Comment to this article:

Commentary: Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize OutcomesArch Plast Surg 2022; 49(03): V3-V3
DOI: 10.1055/s-0043-1777252

Comment to this article:

Commentary: Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize OutcomesArch Plast Surg 2022; 49(03): V4-V4
DOI: 10.1055/s-0043-1777220

 

  • References

  • 1 Bradley PJ. Epidemiology of hypopharyngeal cancer. Adv Otorhinolaryngol 2019; 83: 1-14
    PubMedGoogle Scholar
  • 2 Yu P, Hanasono MM, Skoracki RJ. et al. Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 2010; 116 (07) 1718-1724
    CrossrefPubMedGoogle Scholar
  • 3 Genden EM, Ferlito A, Silver CE. et al. Evolution of the management of laryngeal cancer. Oral Oncol 2007; 43 (05) 431-439
    CrossrefPubMedGoogle Scholar
  • 4 Withrow KP, Rosenthal EL, Gourin CG. et al. Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007; 117 (05) 781-784
    CrossrefPubMedGoogle Scholar
  • 5 Mahalingam S, Srinivasan R, Spielmann P. Quality-of-life and functional outcomes following pharyngolaryngectomy: a systematic review of literature. Clin Otolaryngol 2016; 41 (01) 25-43
    CrossrefPubMedGoogle Scholar
  • 6 Chen HC, Ciudad P, Chen SH, Agko M. Thirty-five years of single surgeon experience in the reconstruction of esophagus and voice with free ileocolon flap following total pharyngolaryngectomy. J Surg Oncol 2018; 117 (03) 459-468
    CrossrefPubMedGoogle Scholar
  • 7 Selber JC, Xue A, Liu J. et al. Pharyngoesophageal reconstruction outcomes following 349 cases. J Reconstr Microsurg 2014; 30 (09) 641-654
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Hsieh YH, Fang TJ, Huang SF. et al. Synchronous reconstruction of esophageal defect and voice with J-flap after laryngopharyngectomy: Indications and outcomes. Oral Oncol 2020; 110: 104947
    CrossrefPubMedGoogle Scholar
  • 9 OCEBM Levels of Evidence Working Group.. The Oxford 2011 Levels of Evidence. Accessed April 11, 2022 at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
    Google Scholar
  • 10 Wells G, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Accessed April 11, 2022 at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    Google Scholar
  • 11 Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018; 23 (02) 60-63
    CrossrefPubMedGoogle Scholar
  • 12 Kawahara H, Shiraishi T, Yasugawa H, Okamura K, Shirakusa T. A new surgical technique for voice restoration after laryngopharyngoesophagectomy with a free ileocolic graft: preliminary report. Surgery 1992; 111 (05) 569-575
    PubMedGoogle Scholar
  • 13 Sartoris A, Succo G, Mioli P, Merlino G. Reconstruction of the pharynx and cervical esophagus using ileocolic free autograft. Am J Surg 1999; 178 (04) 316-322
    CrossrefPubMedGoogle Scholar
  • 14 Rowland RG, Mitchell ME, Bihrle R. Alternative techniques for a continent urinary reservoir. Urol Clin North Am 1987; 14 (04) 797-804
    CrossrefPubMedGoogle Scholar
  • 15 Succo G, Mioli P, Merlino G, Sartoris A. New options for aerodigestive tract replacement after extended pharyngolaryngectomy. Laryngoscope 2000; 110 (10 pt. 1): 1750-1755
    CrossrefPubMedGoogle Scholar
  • 16 Kobayashi M, Onozuka N, Fukuda A, Matsubara A, Kobayashi W. New surgical technique for primary and secondary voice restoration using a free ileocecal patch graft after total laryngectomy. Surg Today 2003; 33 (11) 817-822
    CrossrefPubMedGoogle Scholar
  • 17 Mardini S, Chen HC, Salgado CJ, Özkan O, Cigna E, Chung TT. Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty for reconstruction of a pharyngoesophageal defect: indication and usage of the ‘funnel flap’. J Plast Reconstr Aesthet Surg 2006; 59 (11) 1241-1246
    CrossrefPubMedGoogle Scholar
  • 18 Perrone F, Gharb BB, Rampazzo A, Ngo QD, Chen HC. The use of a chimaeric sero-muscular flap to prevent anastomotic leakage in head and neck reconstruction with free ileocolon flap. J Plast Reconstr Aesthet Surg 2012; 65 (06) 752-756
    CrossrefPubMedGoogle Scholar
  • 19 Hsiao HT, Leu YS, Chang YC, Yang JC, Tung KY. Voice and swallowing after laryngopharyngectomy and free ileocolic flap reconstruction for hypopharyngeal cancer. Ann Plast Surg 2009; 62 (04) 390-394
    CrossrefPubMedGoogle Scholar
  • 20 Rampazzo A, Gharb BB, di Spilimbergo SS, Chung KP, Chen HC. Voice reconstruction with free ileocolon flap transfer: implications for the lower respiratory tract. Plast Reconstr Surg 2011; 127 (05) 1916-1924
    CrossrefPubMedGoogle Scholar
  • 21 Chen HC, Mardini S, Yang CW. Voice reconstruction using the free ileocolon flap versus the pneumatic artificial larynx: a comparison of patients' preference and experience following laryngectomy. J Plast Reconstr Aesthet Surg 2006; 59 (12) 1269-1275
    CrossrefPubMedGoogle Scholar
  • 22 Kobayashi M, Meguro E, Hayakawa Y, Irinoda T, Noda Y. A new technique using free ileocaecal patch transplantation for secondary voice restoration after total laryngectomy. J Plast Reconstr Aesthet Surg 2008; 61 (09) e5-e9
    CrossrefPubMedGoogle Scholar
  • 23 Rampazzo A, Salgado CJ, Gharb BB, Mardini S, di Spilimbergo SS, Chen HC. Donor-site morbidity after free ileocolon flap transfer for esophageal and voice reconstruction. Plast Reconstr Surg 2008; 122 (06) 186e-194e
    CrossrefPubMedGoogle Scholar
  • 24 Leu YS, Huang CM, Yang CC, Hsiao HT, Chang YC. Functional outcome following free ileocolic flap in total pharyngolaryngectomy. Acta Otolaryngol 2008; 128 (06) 702-705
    CrossrefPubMedGoogle Scholar
  • 25 Tai HC, Hsieh CH, Chao KS. et al. Comparison of radiotherapy strategies for locally advanced hypopharyngeal cancer after resection and ileocolic flap reconstruction. Acta Otolaryngol 2009; 129 (03) 311-317
    CrossrefPubMedGoogle Scholar
  • 26 Karri V, Yang MC, Chung KP, Chen SH, Mardini S, Chen HC. Total pharyngolaryngectomy and voice reconstruction with ileocolon free flap: functional outcome and quality of life. J Plast Reconstr Aesthet Surg 2011; 64 (07) 911-920
    CrossrefPubMedGoogle Scholar
  • 27 Gharb BB, Rampazzo A, Hsu CT, Bassetto F, Spanio di Spilimbergo S, Chen HC. Histological changes of the voice tube and possible clinical consequences after voice reconstruction with free ileocolon flap. Ann Plast Surg 2013; 71 (01) 109-113
    CrossrefPubMedGoogle Scholar
  • 28 Tsou YA, Li TS, Tsai MH, Chen HC, Belafsky P. Optimal ileocolic flap length for a reconstructed voice tube after laryngopharyngectomy. J Laryngol Otol 2016; 130 (02) 190-193
    CrossrefPubMedGoogle Scholar
  • 29 Lo Torto F, Manrique OJ, Ciudad P, Agko M, Chung JCK, Chen HC. Pearls and pitfalls of voice reconstruction after pharyngolaryngectomy using the ileocolon free flap. Microsurgery 2017; 37 (05) 453-454
    CrossrefPubMedGoogle Scholar
  • 30 Ciudad P, Agko M, Manrique OJ. et al. The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck. Microsurgery 2017; 37 (08) 902-909
    CrossrefPubMedGoogle Scholar
  • 31 Lo Torto F, Tzu-Liang Chen W, Agko M. et al. Laparoscopic harvest of ileocolon flap in pharyngoesophageal reconstruction. Microsurgery 2017; 37 (06) 737-738
    CrossrefPubMedGoogle Scholar
  • 32 Yang SC, Loh CYY, Tang YB, Chen HC. Using intestinal segments during secondary salvage procedures after failed reconstructions of the cervical oesophagus. Eur J Cardiothorac Surg 2019; 55 (02) 286-291
    CrossrefPubMedGoogle Scholar
  • 33 Yegin ME, Chen SH, Chen HC. Vascular pedicle division during free flap re-inset in pharyngoesophageal reconstruction. Microsurgery 2020; 40 (02) 154-159
    CrossrefPubMedGoogle Scholar
  • 34 Manrique OJ, Sabbagh MD, Kapoor T, Ciudad P, Chen HC. Postoperative management after total pharyngolaryngectomy using the free ileocolon flap: a 5-year surgical intensive care unit experience. Ann Plast Surg 2020; 84 (01) 68-72
    CrossrefPubMedGoogle Scholar
  • 35 Lo Torto F, Ribuffo D, Manrique OJ. et al. Simultaneous restoration of swallowing and voice function with ileocolon free flap. J Craniofac Surg 2020; 31 (04) 916-918
    CrossrefPubMedGoogle Scholar
  • 36 Leu YS, Hsiao HT, Chang YC. et al. Ileocolic free flap reconstruction, concomitant chemotherapy and radiotherapy and assessment of speech and swallowing function during management of advanced cancer of the larynx and hypopharynx: preliminary report. Acta Otolaryngol 2005; 125 (06) 642-646
    CrossrefPubMedGoogle Scholar
  • 37 Merlino G, Bergamin F, Borsetti G. Ileocolic free flap for voice and swallowing rehabilitation after pharyngolaryngo-esophagectomy: a preliminary report. Eur J Plast Surg 2000; 23 (05) 251-255
    CrossrefGoogle Scholar
  • 38 Chen HC, Gharb BB, Rampazzo A, Perrone F, Chen SH, Trignano E. Simultaneous restoration of voice function and digestive tract continuity in patients with synchronous primaries of hypopharynx and thoracic esophagus with pedicled ileocolon flap. Surgery 2011; 149 (05) 662-671
    CrossrefPubMedGoogle Scholar
  • 39 Buck PM, Wax MK, Petrisor DI. Internal mammary vessels: alternate recipient vessels in microvascular head and neck reconstruction. J Oral Maxillofac Surg 2016; 74 (09) 1896.e1-1896.e6
    CrossrefPubMedGoogle Scholar
  • 40 Rossmiller SR, Ghanem TA, Gross ND, Wax MK. Modified ileocolic free flap: viable choice for reconstruction of total laryngopharyngectomy with total glossectomy. Head Neck 2009; 31 (09) 1215-1219
    CrossrefPubMedGoogle Scholar
  • 41 Mardini S, Chen HC, Salgado CJ, Hsu CM, Chen KT, Feng GM. Bowel preparation before microvascular free colon transfer for head and neck reconstruction: is it necessary?. Plast Reconstr Surg 2004; 113 (07) 1916-1922
    CrossrefPubMedGoogle Scholar
  • 42 Hutcheson KA, Lewin JS, Sturgis EM, Risser J. Outcomes and adverse events of enlarged tracheoesophageal puncture after total laryngectomy. Laryngoscope 2011; 121 (07) 1455-1461
    CrossrefPubMedGoogle Scholar
  • 43 Dwivedi RC, Sattar R, Tsiropulous G, Repanos C. Fascia lata graft closure of an enlarged tracheoesophageal puncture (TEP) after laryngectomy/laryngopharyngectomy. Eur Arch Otorhinolaryngol 2019; 276 (08) 2355-2359
    CrossrefPubMedGoogle Scholar
  • 44 Gozen ED, Tevetoglu F, Eker C, Yener HM, Karaman E. A simple and effective method for closure of enlarged tracheoesophageal puncture in seven patients. Clin Otolaryngol 2019; 44 (06) 1224-1227
    CrossrefPubMedGoogle Scholar
  • 45 Chang DW, Hussussian C, Lewin JS, Youssef AA, Robb GL, Reece GP. Analysis of pharyngocutaneous fistula following free jejunal transfer for total laryngopharyngectomy. Plast Reconstr Surg 2002; 109 (05) 1522-1527
    CrossrefPubMedGoogle Scholar
  • 46 Disa JJ, Cordeiro PG. Reconstruction of the hypopharynx and cervical esophagus. Clin Plast Surg 2001; 28 (02) 349-360
    CrossrefPubMedGoogle Scholar
  • 47 Head C, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Blackwell KE. Microvascular reconstruction after previous neck dissection. Arch Otolaryngol Head Neck Surg 2002; 128 (03) 328-331
    CrossrefPubMedGoogle Scholar
  • 48 Urken ML, Vickery C, Weinberg H, Buchbinder D, Biller HF. The internal oblique-iliac crest osseomyocutaneous microvascular free flap in head and neck reconstruction. J Reconstr Microsurg 1989; 5 (03) 203-214
    Article in Thieme ConnectPubMedGoogle Scholar
  • 49 Orfaniotis G, Sacak B, Nicoli F. et al. Absence of the ileocolic artery: Microsurgical implications in reconstruction of the esophagus with the free ileocolon flap. Microsurgery 2016; 36 (02) 173-174
    CrossrefPubMedGoogle Scholar
  • 50 Kushida-Contreras BH, Manrique OJ, Gaxiola-García MA. Head and neck reconstruction of the vessel-depleted neck: a systematic review of the literature. Ann Surg Oncol 2021; 28 (05) 2882-2895
    CrossrefPubMedGoogle Scholar
  • 51 Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009; 29 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 52 Plant RL, Freed GL, Plant RE. Direct measurement of onset and offset phonation threshold pressure in normal subjects. J Acoust Soc Am 2004; 116 (06) 3640-3646
    CrossrefPubMedGoogle Scholar
  • 53 Revenaugh PC, Knott PD, Alam DS, Kmiecik J, Fritz MA. Voice outcomes following reconstruction of laryngopharyngectomy defects using the radial forearm free flap and the anterolateral thigh free flap. Laryngoscope 2014; 124 (02) 397-400
    CrossrefPubMedGoogle Scholar
  • 54 Perrone F, Gharb BB, Rampazzo A, Ngo QD, Chen SH, Chen HC. Evaluation and management of complications or functional problems at the recipient site after esophageal and voice reconstruction with free ileocolon flap. Surgery 2013; 153 (03) 373-382.e2
    CrossrefPubMedGoogle Scholar
  • 55 Deschler DG, Herr MW, Kmiecik JR, Sethi R, Bunting G. Tracheoesophageal voice after total laryngopharyngectomy reconstruction: jejunum versus radial forearm free flap. Laryngoscope 2015; 125 (12) 2715-2721
    CrossrefPubMedGoogle Scholar
  • 56 Carlson GW, Schusterman MA, Guillamondegui OM. Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience. Ann Plast Surg 1992; 29 (05) 408-412
    CrossrefPubMedGoogle Scholar
  • 57 Murray DJ, Novak CB, Neligan PC. Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1148-1156
    CrossrefPubMedGoogle Scholar
  • 58 Denewer A, Khater A, Hafez MT. et al. Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases. World J Surg Oncol 2014; 12 (182) 182
    CrossrefPubMedGoogle Scholar
  • 59 Spyropoulou GC, Lin PY, Chien CY, Kuo YR, Jeng SF. Reconstruction of the hypopharynx with the anterolateral thigh flap: defect classification, method, tips, and outcomes. Plast Reconstr Surg 2011; 127 (01) 161-172
    CrossrefPubMedGoogle Scholar
  • 60 Moradi P, Glass GE, Atherton DD. et al. Reconstruction of pharyngolaryngectomy defects using the jejunal free flap: a 10-year experience from a single reconstructive center. Plast Reconstr Surg 2010; 126 (06) 1960-1966
    CrossrefPubMedGoogle Scholar
  • 61 Reece GP, Schusterman MA, Miller MJ. et al. Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus. Plast Reconstr Surg 1995; 96 (06) 1307-1316
    CrossrefPubMedGoogle Scholar
  • 62 Sharp DA, Theile DR, Cook R, Coman WB. Long-term functional speech and swallowing outcomes following pharyngolaryngectomy with free jejunal flap reconstruction. Ann Plast Surg 2010; 64 (06) 743-746
    CrossrefPubMedGoogle Scholar
  • 63 Barmparas G, Branco BC, Schnüriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 2010; 14 (10) 1619-1628
    CrossrefPubMedGoogle Scholar