Surgical Treatment of Persistent Dysphagia in Stroke Patients Using a Newly Reconstructed Conduit from the Anterior Mouth

Hui-Hsiu Chang; Samir Mardini; Wen-Hsuan Hou; Yueh-Bih Tang; Christopher J. Salgado; Prashanth Varkey; Hung-Chi Chen

doi:10.1055/s-2007-985211

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2007; 23(5): 283-288
DOI: 10.1055/s-2007-985211

Surgical Treatment of Persistent Dysphagia in Stroke Patients Using a Newly Reconstructed Conduit from the Anterior Mouth

Hui-Hsiu Chang¹ ^, ² , Samir Mardini¹ ^, ⁴ , Wen-Hsuan Hou³ , Yueh-Bih Tang² , Christopher J. Salgado¹ , Prashanth Varkey¹ , Hung-Chi Chen¹

¹Department of Plastic Surgery, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, R.O.C.
²Department of Plastic Surgery, National Taiwan University Hospital, Taipei
³Department of Physical Medicine and Rehabilitation, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, R.O.C.
⁴Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota

Abstract

ABSTRACT

Dysphagia is common after stroke and may result in malnutrition and aspiration. To prevent the risk of aspiration and to improve the nutritional status, patients with dysphagic stroke have to give up oral intake and become dependent on tube feeding. Restoration of the patients' ability to resume aspiration free oral feeding is important. A 55-year-old male presented following a brainstem stroke and dysphagia. He was treated with a free jejunal flap to divert food from the anterior mouth to the cervical esophagus. Although the flap underwent partial loss, this was reconstructed with a tubed deltopectoral flap, and following a revision procedure for stricture, the patient's diet was advanced to a regular diet. At follow-up, the patient was able to eat by mouth without tube feeding. The application of this diversion technique to treat patients with a medical disease (i.e., stroke) is a step toward resuming oral feedings in this group of patients.

KEYWORDS

Dysphagia - stroke - reconstruction

Full Text

References

REFERENCES

1 Hinds N P, Wiles C M. Assessment of swallowing and referral to speech and language therapists in acute stroke. Q J Med. 1998; 91 829-835
2 Wade D T, Langton H R. Motor loss and swallowing difficulty after stroke: frequency, recovery and prognosis. Acta Neurol Scand. 1997; 76 50-54
3 Daniels S K, Brailey K, Priestly D H et al.. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998; 79 14-19
4 Daniels S K, Brailey K, Foundas A L. Lingual disco-ordination and dysphagia following acute stroke: analysis of lesion location. Dysphagia. 1999; 14 85-92
5 Mann G, Hankey G J, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999; 30 744-748
6 Meng N H, Wang T G, Lien I N. Dysphagia with patients with brain stem stroke: incidence and outcome. Am J Phys Med Rehabil. 2000; 79 170-175
7 Doggett D L, Tappe K A, Mitchell M D et al.. Prevention of pneumonia in elderly stroke patients by systemic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia. 2001; 16 279-295
8 Wanklyn P, Cox N, Belfield P. Outcome in patients who require a gastrostomy after stroke. Age Ageing. 1995; 24 510-514
9 Chen H C, Chana J S, Chang C H 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; 12 1528-1533
10 Logemann J A. Evaluation and Treatment of Swallowing Disorder. 2nd ed. Austin, TX; Pro-Ed 1998
11 Ding R, Larson C R, Logemann J A et al.. Surface electromyographic and eletroglottographic studies in normal subjects under two swallowing conditions: normal and during Mendelson maneuver. Dysphagia. 2002; 17 1-12
12 Huckabee M, Cannito M P. Outcomes of swallowing rehabilitation in chronic brain dysphagia: a retrospective evaluation. Dysphagia. 1999; 14 93-109
13 Smithard D G, O'Neill P A, England R et al.. The natural history of dysphagia following a stroke. Dysphagia. 1997; 12 188-193
14 Finestone H M, Greene-Finestone L S, Wilson E S et al.. Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. Arch Phys Med Rehabil. 1995; 76 310-316
15 Broadley S, Croser D, Cottrell J et al.. Predictors of prolonged dysphagia following acute stroke. J Clin Neurosci. 2003; 10 300-305
16 Brandstater M E. Stroke rehabilitation. In: Delisa JA, Gans BM, Walsh NE Physical Medicine and Rehabilitation: Principles and Practice. Vol. 2. 4th ed. Philadelphia; Wolters Kluwer Company 2005: 1671
17 Özkan Ö, Mardini S, Salgado C J et al.. Tubed deltopectoral flap for creation of a controlled esophagocutaneous fistula in patients with persistent choking following esophageal reconstruction with free diversionary jejunum. Ann Plast Surg. 2005; 55 648-653
18 Kelly J H. Management of upper esophageal sphincter disorders: indications and complications of myotomy. Am J Med. 2000; 108 43S-45S
19 Wisdom G, Blitzer A. Surgical therapy for swallowing disorders. Otolarng Clin N Am. 1998; 31 537-560
20 Albery J, Oelerich M, Lugwig K et al.. Efficacy of botulinum toxin A for treatment of upper esophageal sphincter dysfunction. Laryngoscope. 2000; 110 1151-1156

Hung-Chi ChenM.D.

Department of Plastic Surgery, E-Da Hospital/I-Shou University

1 E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, Kaohsiung County 824, Taiwan, R.O.C.