Edge deepithelialization: A method to prevent leakage when tubed free skinflap is used for pharyngoesophageal reconstruction

Background. Anastomosis leakage remains a major source of morbidity and mor tality in patients who receive pharyngoesophageal reconstruction, especiall y when a free skin flap is used as the substitute. This makes free skin fla ps less favored than other substitutes in pharyngoesophageal reconstruction . However, a free skin flap provider many advantages for pharyngoesophageal reconstruction and, in some circumstances, may be the only choice. To redu ce the incidence of postoperative leakage, we developed a technical modific ation called edge-deepithelialization for skin flaps to ensure a more secur e anastomosis. Methods. Twenty-four patients who received tubed free skin flaps for cervic al esophagus or hypopharynx reconstruction during a 7-year period were incl uded in this study. Group 1 (n = 12) received flap edge-deepithelialization before undergoing the anastomosis, and Group 2 (n = 12) received the conve ntional anastomosis method. Preoperative nutritional status was evaluated b y serum albumin level. All the patients were followed up for at least 1 yea r (1 similar to 14 years, mean, 7.3 years). Postoperative leakage was detec ted by clinical symptoms and signs or by routine esophagography. Results. Postoperative anastomosis leakage developed in 1 patient in Group 1 (8.3%) and 5 patients in Group 2 (41.67%). The difference in the leakage rate between these groups was of statistical significance (P = .0001). Ther e were no significant differences in the preoperative serum albumin level n oted between these 2 groups (t test, P > .05). Older age was not associated with a higher leakage rate. Among the 6 leakage cases, 1 was treated conse rvatively, and the other 5 needed an additional 1 to 5 procedures for the m anagement of leakage. All the leakages were cured during the follow-up peri od. Conclusion. With the flap edge deepithelialized, a more secure and reliable anastomosis can be obtained. This makes the free skin flap an easier and s afer alternative in pharyngoesophageal reconstruction, especially when lapa rotomy and enteric flaps are contraindicated.