Use of the radial forearm free tissue flap to treat persistent stricture after esophagogastrectomy

Clifford Deveney, Scott Soot, Blair Jobe, James Cohen, Peter Anderson, Mark Wax, Michael Wheatley, Brett Sheppard

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Persistent stricturing or anastomotic leakage at the cervical esophagogastric anastomosis can be a troublesome complication of gastric pull-up procedures. When the stricture is the result of ischemia of the stomach, the strictures are long and often not responsive to dilatation and require large operations such as jejunal interposition or replacement with colonic pull-up. In this report we describe the use of a radial forearm flap to patch strictures. Methods: The radial forearm flap is a fascia cutaneous flap taken from the forearm and based on the radial artery and its venae comitantes. The advantages of this flap are that it is thin and pliable, conforms easily, has excellent reliability due to the size of the feeding vessels, and has a relatively long pedicle. The vascular anastomosis can be made to several arteries and veins within the neck. The epithelial component can be made in sizes up to 10 by 20 cm. Results: We have used the radial forearm flap to patch strictures in 6 patients with persistent complex strictures in the cervical region after esophagectomy. Results were excellent in 4 patients (able to eat liquids and solids without problems) and good in 1 patient (liquids okay, some problem with solids), and 1 patient died postoperatively. Follow-up is 4 months to 7 years. Conclusions: The radial forearm flap is an excellent option for handling persistent stricture after esophagogastrectomy. In many instances, this flap can be used in lieu of a jejunal interposition flap and obviates a laparotomy to harvest jejunum. The flap fits easily into the neck and conforms to the space.

Original languageEnglish (US)
Pages (from-to)459-462
Number of pages4
JournalAmerican Journal of Surgery
Volume181
Issue number5
DOIs
StatePublished - 2001

Fingerprint

Free Tissue Flaps
Forearm
Pathologic Constriction
Stomach
Neck
Anastomotic Leak
Radial Artery
Esophagectomy
Fascia
Jejunum
Laparotomy
Blood Vessels
Dilatation
Veins
Ischemia
Arteries
Skin

Keywords

  • Cervical anastomosis
  • Radial forearm free flap

ASJC Scopus subject areas

  • Surgery

Cite this

Use of the radial forearm free tissue flap to treat persistent stricture after esophagogastrectomy. / Deveney, Clifford; Soot, Scott; Jobe, Blair; Cohen, James; Anderson, Peter; Wax, Mark; Wheatley, Michael; Sheppard, Brett.

In: American Journal of Surgery, Vol. 181, No. 5, 2001, p. 459-462.

Research output: Contribution to journalArticle

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AU - Deveney, Clifford

AU - Soot, Scott

AU - Jobe, Blair

AU - Cohen, James

AU - Anderson, Peter

AU - Wax, Mark

AU - Wheatley, Michael

AU - Sheppard, Brett

PY - 2001

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N2 - Background: Persistent stricturing or anastomotic leakage at the cervical esophagogastric anastomosis can be a troublesome complication of gastric pull-up procedures. When the stricture is the result of ischemia of the stomach, the strictures are long and often not responsive to dilatation and require large operations such as jejunal interposition or replacement with colonic pull-up. In this report we describe the use of a radial forearm flap to patch strictures. Methods: The radial forearm flap is a fascia cutaneous flap taken from the forearm and based on the radial artery and its venae comitantes. The advantages of this flap are that it is thin and pliable, conforms easily, has excellent reliability due to the size of the feeding vessels, and has a relatively long pedicle. The vascular anastomosis can be made to several arteries and veins within the neck. The epithelial component can be made in sizes up to 10 by 20 cm. Results: We have used the radial forearm flap to patch strictures in 6 patients with persistent complex strictures in the cervical region after esophagectomy. Results were excellent in 4 patients (able to eat liquids and solids without problems) and good in 1 patient (liquids okay, some problem with solids), and 1 patient died postoperatively. Follow-up is 4 months to 7 years. Conclusions: The radial forearm flap is an excellent option for handling persistent stricture after esophagogastrectomy. In many instances, this flap can be used in lieu of a jejunal interposition flap and obviates a laparotomy to harvest jejunum. The flap fits easily into the neck and conforms to the space.

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