Microsurgical reconstruction for caustic injuries of the oral cavity and esophagus

Ingestion of caustic material often produces profound and irreversible path ologic changes that require reconstructive surgery of the organs damaged. T his report describes the authors' successful experience with microsurgical techniques that allowed adequate reconstruction in three patients with cica tricial contracture of the oral cavity and esophagus following ingestion of caustic substances. All patients had attempted suicide by ingesting liquid alkali. Patients #1 and #2 complained of limited mouth opening and impaired tongue movement due to oral scar contracture. Contracture release in the first patient resulte d in a defect from the anterior border of the mandible to the retromolar re gion. The defect was resurfaced with a 6 x 12 cm free forearm flap. Release of the scar contracture in the second patient resulted in a long, narrow, tortuous defect that was difficult to cover, even with a forearm flap, and a jejunal segment was microsurgically transferred as a patch graft to recon struct the defect. Patient #3 had dysphagia due to stricture of the cervica l portion of the esophagus. The defect after resection of the cervical port ion was reconstructed by free jejunal interposition. Appropriately selected free-flap transfer in each case provided a satisfact ory restoration of function of the oropharyngeal and digestive passages.