Corrosive Injuries to Esophagus Following Double Suicide Attempts: Use of a Combined Free and Pedicled Jejunum Flap in Esophageal Reconstruction

二次自殺引起的食道燒灼傷：使用合併自由空腸皮瓣及蒂狀空腸皮瓣做為食道重建

陳歷舜(Li-Shun Chen) ； 張立人(Li-Ren Chang) ； 劉奕添(Yi-Tien Liu) ； 姚勝發(Sheng-Fa Yao) ； 馮冠明(Kuan-Ming Feng) ； 陳宏基(Hung-Chi Chen)

《臺灣整形外科醫學會雜誌》 20卷3期 (2011/09) Pp. 230-235

https://doi.org/10.7096/TJTSPS.201109.0230

摘要

背景：在整段食道重建中，蒂狀結腸皮瓣是第一選擇。但在病人在第二次飲食侵蝕性液嘗試自殺時，先前以蒂狀結腸皮瓣重建的食道就被摧毀了，使得重建更加困難。目的及目標：在結腸皮瓣因腐蝕而不能再使用時，這篇病例報告敘述使用自由合併蒂狀空腸皮瓣來做爲食道重建。材料及方法：先利用自由空腸皮瓣來重建頸部及上段食道。等一個月後皮瓣穩定及近端穩合處無滲露，再以蒂狀空腸皮瓣來重建下段食道。結果：我們成功地重建病人的食道，且病人可以經由口進食，不需空腸造口。結論：在結腸及胃都不能再作爲食道重建時，以分階段方式結合自由空腸皮瓣及蒂狀空腸皮瓣來重建食道是可行的。

並列摘要

Background:Pedicled colon flap had been first choice in cases of whole esophagus reconstruction. A patient had received pedicled colon flap reconstruction for previous corrosive injury and attempted suicide for second time by swallowing corrosive fluid. In this situation, previously used colon segment had been destroyed, thus making reconstruction more difficult.Aim and Objectives:This case report describes the technical aspects of using staged combined free jejunum flap and pedicled jejunum flap in total esophageal reconstruction.Materials and Methods:Firstly, a free jejunal flap was used to reconstruct the cervical and upper thoracic portion of the esophagus. The proximal end was anastomosed but the distal end was left open on the chest wall. One month later, when the free jejunum flap was stable and the proximal anastomosis site was secured, a pedicled jejunal flap was haervested to reconstruct of the lower esophagus.Result:The esophagus was successfully reconstructed and the patient was able to take food orally without feeding from jejunostomy.Conclusion:Esophageal reconstruction using a combination of free and pedicled jejunum flap can be successfully achieved in patients whose colon or stomach is not available to be pedicled flaps for reconstruction.

並列關鍵字

esophageal reconstruction ； free jejunum flap ； pedicled jejunum flap