Free transverse colon transplantation for functional reconstruction of intra-oral lining: A clinical and histologic study

A variety of free-tissue transplantations are available for oropharyngeal ( lining) reconstruction. The most commonly used flap, the radial forearm fla p, is relatively thin, adaptable, and reliable but does not provide lubrica tion. In this study, the potential of the transverse colon to provide a lub ricating tissue for replacement of oral lining was investigated. Eleven patients requiring replacement of oral lining received transverse co lon flap transplantation between November of 1993 and December of 1995. The re was one complete flap loss and one partial loss. Flap size used for reco nstruction averaged 40.4 cm(2), and average vessel length and diameter were 7 cm and 2.0 mm, respectively. In a followup period from 15 to 48 months, all colon flaps proved to be durable with continuous lubrication function. Histologic assessment of the transplanted colon flaps at various postoperat ive times slowed an adequate amount of mucus-secreting goblet cells even af ter irradiation. There was no donor-site morbidity. The main disadvantage s eemed a tendency to transplant too much tissue, which resulted in formation of redundant pockets affecting food handling. Thus, 8 out of 10 patients w ith flap survival required one to three debulking procedures. Given an accu rate estimation of the area of mucosa defect and adequate trimming of the c olon flaps, the transverse colon flap offers a good alternative for reconst ruction of the oral lining, especially when lubrication is desirable in cas es with large defects and preoperative or postoperative irradiation, or in case a radial forearm flap is not available.