Multi-Disciplinary Surgical Approach to Esophageal Reconstruction: The Role of the Plastic Surgeon

Main Article Content

Lawrence Z. Cai, MD Janos A. Barrera, MD Irene T. Ma, MD Gordon K. Lee, MD

Abstract

Reconstruction of the esophagus is a highly interdisciplinary undertaking that involves a wide range of specialties in all phases of care. Esophageal reconstruction may be indicated for a number of reasons, which range from oncologic resection to traumatic injuries to congenital defects. The ultimate goals of esophageal reconstruction are to provide soft tissue coverage of the defect, restore continuity of the gastrointestinal (GI) tract, create a functional conduit, and allow for oral intake. This can be achieved through a number of different surgical techniques, which depend on the extent of the defect. For non-circumferential patch defects of the esophagus, local muscle flaps from the neck and trunk are commonly used. For shorter segmental defects, interposition small intestine free flaps or tubularized fasciocutaneous flaps from the extremities are employed. For longer segmental defects, sections of the native GI tract (such as stomach, colon, or jejunum) are recruited to reconstruct the esophagus. The most common complications of esophageal reconstruction include fistula formation, which can typically be managed conservatively, and conduit strictures, which may require serial dilation. Long-term outcomes are typically favorable, with good restoration of swallowing and speech and overall high quality of life in long-term survivors. New developments in tissue engineering involving the use of biological substitutes have also shown promise in esophageal reconstruction. These methods involve the placement of biologic matrices, autologous cells and/or growth factors to restore continuity of the esophagus. In this review, we discuss the role of plastic surgery in the reconstruction of the esophagus.

Keywords: esophageal reconstruction, multidisciplinary care, patch flaps, tubularized flaps, quality of life, bioengineering, plastic surgery

Article Details

How to Cite
CAI, Lawrence Z. et al. Multi-Disciplinary Surgical Approach to Esophageal Reconstruction: The Role of the Plastic Surgeon. Medical Research Archives, [S.l.], v. 8, n. 5, may 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2090>. Date accessed: 24 feb. 2024. doi: https://doi.org/10.18103/mra.v8i5.2090.
Section
Research Articles

References

1. Mikulicz J. Ein Fall von Resection des carcinomatosen Oesophagus mit plastichem Ersatz des excirdirten Stuckes. Prager Med. Wschr. 1886(11):93.
2. Aghajanzadeh M, Safarpour F, Koohsari MR, et al. Functional outcome of gastrointestinal tract and quality of life after esophageal reconstruction of esophagus cancer. Saudi J Gastroenterol. 2009;15(1):24–28.
3. Lee MK, Yost KJ, Pierson KE, Blackmon SH. Patient-reported outcome domains for the esophageal CONDUIT report card: a prospective trial to establish domains. Health Qual Life Outcomes. 2018;16(1):197.
4. Low DE, Kunz S, Schembre D, et al. Esophagectomy--it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J. Gastrointest. Surg. 2007;11(11):1395–1402; discussion 1402.
5. Barzin A, Norton JA, Whyte R, Lee GK. Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis. Plast. Reconstr. Surg. 2011;127(1):173–180.
6. Lee GK, Yamin F, Ho OH. Vertical island trapezius myocutaneous flap for cervical esophagoplasty: case report and review of the literature. Ann Plast Surg. 2012;68(4):362–365.
7. Noland SS, Ingraham JM, Lee GK. The sternocleidomastoid myocutaneous “patch esophagoplasty” for cervical esophageal stricture. Microsurgery. 2011;31(4):318–322.
8. Moody L, Hunter C, Nazerali R, Lee GK. The Use of the Sternocleidomastoid Flap Helps Reduce Complications After Free Jejunal Flap Reconstructions in Total Laryngectomy and Cervical Esophagectomy Defects. Ann Plast Surg. 2016;76 Suppl 3:S209-212.
9. Frimpong-Boateng K. Sternocleidomastoid myocutaneous esophagoplasty. Eur J Cardiothorac Surg. 1994;8(12):660–662.
10. Kierner AC, Zelenka I, Gstoettner W. The sternocleidomastoid flap--its indications and limitations. Laryngoscope. 2001;111(12):2201–2204.
11. Lamberty BGH. The supra-clavicular axial patterned flap. British Journal of Plastic Surgery. 1979;32(3):207–212.
12. Atallah S, Guth A, Chabolle F, Bach C-A. Supraclavicular artery island flap in head and neck reconstruction. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(5):291–294.
13. Chiu ES, Liu PH, Baratelli R, et al. Circumferential pharyngoesophageal reconstruction with a supraclavicular artery island flap. Plast. Reconstr. Surg. 2010;125(1):161–166.
14. Demergasso F, Piazza MV. Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: an original technique. Am. J. Surg. 1979;138(4):533–536.
15. Castillo MH, Peoples JB, Machicao CN, Singhal PK. The lateral island trapezius myocutaneous flap for circumferential reconstruction of hypopharynx and cervical esophagus. Dig Surg. 2001;18(2):93–97.
16. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast. Reconstr. Surg. 1979;63(1):73–81.
17. Baek SM, Biller HF, Krespi YP, Lawson W. The pectoralis major myocutaneous island flap for reconstruction of the head and neck. Head Neck Surg. 1979;1(4):293–300.
18. Koh KS, Eom JS, Kirk I, Kim SY, Nam S. Pectoralis major musculocutaneous flap in oropharyngeal reconstruction: revisited. Plast. Reconstr. Surg. 2006;118(5):1145–1149; discussion 1150.
19. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984;37(2):149–159.
20. Deptula P, Miller T, Cai L, Lee G. The Anterolateral Thigh Flap: Clinical Applications and Review of the Literature. Biomedical Journal of Scientific & Technical Research. 2018;7:.
21. Komorowska-Timek E, Lee GK. Tube-in-a-tube anterolateral thigh flap for reconstruction of a complex esophageal and anterior neck defect. Ann Plast Surg. 2014;72(1):64–66.
22. YANG G. Forearm free skin flap transplantation ; report of 56 cases. National Medical Journal of China. Med. J. China. 1981;61:139.
23. Kirschner M. in neues Verfahren der Osophagusplastik. Arch Klin Chir. 1920(114):2–59.
24. Vuillet H. De l’oesophagoplastie, et des diverses modifications. Semin Med. 1911(31):529.
25. Roux C. A new operation for intractable obstruction of the esophagus (L’oesophago-jejuno-gastrosiose, nouvelle operation pour retrecisse- ment infranchissable del’oesophage). Semin Med. 1907(27):34–40.
26. Longmire WP, Ravitch MM. A New Method for Constructing an Artificial Esophagus. Ann Surg. 1946;123(5):819–834.
27. Luan A, Hunter CL, Crowe CS, Lee GK. Comparison of Outcomes of Total Esophageal Reconstruction With Supercharged Jejunal Flap, Colonic Interposition, and Gastric Pull-up. Ann Plast Surg. 2018;80(5S Suppl 5):S274–S278.
28. Mardini S, Salgado CJ, Kim Evans KF, Chen H-C. Reconstruction of the esophagus and voice. Plast. Reconstr. Surg. 2010;126(2):471–485.
29. Clark JR, Gilbert R, Irish J, et al. Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope. 2006;116(2):173–181.
30. Azizzadeh B, Yafai S, Rawnsley JD, et al. Radial forearm free flap pharyngoesophageal reconstruction. Laryngoscope. 2001;111(5):807–810.
31. van Boeckel PGA, Siersema PD. Refractory Esophageal Strictures: What To Do When Dilation Fails. Curr Treat Options Gastroenterol. 2015;13(1):47–58.
32. Popovici Z. A new philosophy in esophageal reconstruction with colon. Thirty-years experience. Dis. Esophagus. 2003;16(4):323–327.
33. Triboulet JP, Mariette C, Chevalier D, Amrouni H. Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases. Arch Surg. 2001;136(10):1164–1170.
34. Sarukawa S, Asato H, Okazaki M, et al. Clinical evaluation and morbidity of 201 free jejunal transfers for oesophagopharyngeal reconstruction during the 20 years 1984-2003. Scand J Plast Reconstr Surg Hand Surg. 2006;40(3):148–152.
35. Donington JS. Functional conduit disorders after esophagectomy. Thorac Surg Clin. 2006;16(1):53–62.
36. Chen K-N. Managing complications I: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis. 2014;6(Suppl 3):S355–S363.
37. Chandos B. Dumping syndrome and the regulation of peptide YY with verapamil. Am. J. Gastroenterol. 1992;87(10):1530–1531.
38. Shibata C, Funayama Y, Fukushima K, et al. Effect of steroid therapy for late dumping syndrome after total gastrectomy: report of a case. Dig. Dis. Sci. 2004;49(5):802–804.
39. Vecht J, Lamers CB, Masclee AA. Long-term results of octreotide-therapy in severe dumping syndrome. Clin. Endocrinol. (Oxf). 1999;51(5):619–624.
40. Greene CL, DeMeester SR, Augustin F, et al. Long-term quality of life and alimentary satisfaction after esophagectomy with colon interposition. Ann. Thorac. Surg. 2014;98(5):1713–1719; discussion 1719-1720.
41. Blackmon SH, Correa AM, Skoracki R, et al. Supercharged pedicled jejunal interposition for esophageal replacement: a 10-year experience. Ann. Thorac. Surg. 2012;94(4):1104–1111; discussion 1111-1113.
42. Moore JM, Hooker CM, Molena D, et al. Complex Esophageal Reconstruction Procedures Have Acceptable Outcomes Compared With Routine Esophagectomy. Ann. Thorac. Surg. 2016;102(1):215–222.
43. Hamai Y, Hihara J, Emi M, Aoki Y, Okada M. Esophageal reconstruction using the terminal ileum and right colon in esophageal cancer surgery. Surg. Today. 2012;42(4):342–350.
44. Poghosyan T, Catry J, Luong-Nguyen M, et al. Esophageal tissue engineering: Current status and perspectives. J Visc Surg. 2016;153(1):21–29.
45. Freud E, Efrati I, Kidron D, Finally R, Mares AJ. Comparative experimental study of esophageal wall regeneration after prosthetic replacement. J. Biomed. Mater. Res. 1999;45(2):84–91.
46. Macchiarini P, Mazmanian GM, de Montpréville V, et al. Experimental tracheal and tracheoesophageal allotransplantation. Paris-Sud University Lung Transplantation Group. J. Thorac. Cardiovasc. Surg. 1995;110(4 Pt 1):1037–1046.
47. Tessier W, Mariette C, Copin M-C, et al. Replacement of the esophagus with fascial flap–wrapped allogenic aorta. Journal of Surgical Research. 2015;193(1):176–183.
48. Gaujoux S, Le Balleur Y, Bruneval P, et al. Esophageal replacement by allogenic aorta in a porcine model. Surgery. 2010;148(1):39–47.
49. Le Baleur Y, Gaujoux S, Bruneval P, et al. Self-expanding removable plastic stents for the protection of surgical anastomoses after esophageal replacement in a porcine model. Gastrointestinal Endoscopy. 2010;72(4):790–795.
50. Yamato M, Okano T. Cell sheet engineering. Materials Today. 2004;7(5):42–47.
51. Gandhi A, Paul A, Sen SO, Sen KK. Studies on thermoresponsive polymers: Phase behaviour, drug delivery and biomedical applications. Asian Journal of Pharmaceutical Sciences. 2015;10(2):99–107.
52. Yang J, Yamato M, Kohno C, et al. Cell sheet engineering: recreating tissues without biodegradable scaffolds. Biomaterials. 2005;26(33):6415–6422.
53. Ohki T, Yamato M, Murakami D, et al. Treatment of oesophageal ulcerations using endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets in a canine model. Gut. 2006;55(12):1704–1710.
54. Perrod G, Rahmi G, Pidial L, et al. Cell Sheet Transplantation for Esophageal Stricture Prevention after Endoscopic Submucosal Dissection in a Porcine Model. PLoS ONE. 2016;11(3):e0148249.
55. Ohki T, Yamato M, Ota M, et al. Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets. Gastroenterology. 2012;143(3):582-588.e2.
56. Ohki T, Yamato M, Ota M, et al. Application of regenerative medical technology using tissue-engineered cell sheets for endoscopic submucosal dissection of esophageal neoplasms. Dig Endosc. 2015;27(2):182–188.
57. Maeda M, Kanai N, Kobayashi S, et al. Endoscopic cell sheet transplantation device developed by using a 3-dimensional printer and its feasibility evaluation in a porcine model. Gastrointest. Endosc. 2015;82(1):147–152.
58. Vert M. Aliphatic polyesters: great degradable polymers that cannot do everything. Biomacromolecules. 2005;6(2):538–546.
59. Zhu Y, Chan-Park MB, Sin Chian K. The growth improvement of porcine esophageal smooth muscle cells on collagen-grafted poly(DL-lactide-co-glycolide) membrane. J. Biomed. Mater. Res. 2005;75B(1):193–199.
60. Yamamoto Y, Nakamura T, Shimizu Y, et al. Intrathoracic esophageal replacement in the dog with the use of an artificial esophagus composed of a collagen sponge with a double-layered silicone tube. J. Thorac. Cardiovasc. Surg. 1999;118(2):276–286.
61. Saito M, Sakamoto T, Fujimaki M, et al. Experimental study of an artificial esophagus using a collagen sponge, a latissimus dorsi muscle flap, and split-thickness skin. Surg. Today. 2000;30(7):606–613.
62. Doede T, Bondartschuk M, Joerck C, Schulze E, Goernig M. Unsuccessful alloplastic esophageal replacement with porcine small intestinal submucosa. Artif Organs. 2009;33(4):328–333.
63. Lopes MF, Cabrita A, Ilharco J, et al. Esophageal replacement in rat using porcine intestinal submucosa as a patch or a tube-shaped graft. Dis. Esophagus. 2006;19(4):254–259.
64. Arakelian L, Kanai N, Dua K, et al. Esophageal tissue engineering: from bench to bedside. Ann. N. Y. Acad. Sci. 2018;1434(1):156–163.
65. Duscher D, Barrera J, Wong VW, et al. Stem Cells in Wound Healing: The Future of Regenerative Medicine A Mini-Review. Gerontology. 2015;
66. Nombela-Arrieta C, Ritz J, Silberstein LE. The elusive nature and function of mesenchymal stem cells. Nat. Rev. Mol. Cell Biol. 2011;12(2):126–131.
67. Phinney DG, Pittenger MF. Concise Review: MSC-Derived Exosomes for Cell-Free Therapy. Stem Cells. 2017;35(4):851–858.
68. Hiroko, Satoh H, Kishi K, et al. Transplanted mesenchymal stem cells are effective for skin regeneration in acute cutaneous wounds. CELLULAR AND MOLECULAR BIOLOGY RESEARCH. 13(4):405–412.
69. Spurrier RG, Speer AL, Hou X, El-Nachef WN, Grikscheit TC. Murine and human tissue-engineered esophagus form from sufficient stem/progenitor cells and do not require microdesigned biomaterials. Tissue Eng Part A. 2015;21(5–6):906–915.
70. La Francesca S, Aho JM, Barron MR, et al. Long-term regeneration and remodeling of the pig esophagus after circumferential resection using a retrievable synthetic scaffold carrying autologous cells. Sci Rep. 2018;8(1):4123.
71. Nakase Y, Nakamura T, Kin S, et al. Intrathoracic esophageal replacement by in situ tissue-engineered esophagus. J. Thorac. Cardiovasc. Surg . 2008;136(4):850–859.