The use of latex Penrose drains and vascular vessel loops to prevent adherence formation in case of delayed flap harvesting

Abstract

Dear Editor, In the present letter, we would like to share our experience with a simple but still very useful technique for prevention of adherence in case of a delay in flap harvest caused by intra-operative complications. When facing a large reconstructive surgery, free tissue transfer is often required and the surgeons usually perform the flap harvest at the same time of the resection. This allows two surgical teams to work simultaneously, thus reducing the duration of the operation. This approach is particularly useful when the recipient and donor sites are sufficiently distant from each other. In the present case, a posterior tibial artery (PTA) perforator flap was designed for the closure of a radiation therapy-induced esophageal fistula after two failed reconstructions of with local flaps (Figure 1(a)). Sometimes, during the primary oncologic surgery, complications might occur that contraindicate an immediate reconstruction, as happened in the present case. The involved patient presented a hypopharynx squamous cell carcinoma which was initially treated with radiotherapy that caused a stricture limiting the swallowing function. This complication was then faced by the gastroenterology team using a dilating stent, which unfortunately caused a fistula. After that, the ENT surgeons tried to solve this further complication at first with a thyroid gland flap, and later with a pedicled pectoral flap. This second flap was totally lost, causing the presence of necrotic tissue in the recipient area which was then debrided in another operation, while