Hildegunde Piza

Jejunal Grafts for Reconstructing a Phonatory Neoglottis in Laryngectomized Patients

SummaryAfter laryngopharyngectomy and reconstruction of the upper digestive tract, a free jejunal graft can be anastomosed in an isoperistaltic direction end-to-end to the trachea and the hypopharynx in order to form a shunt for vocal rehabilitation. Following placement of the shunt, no special care is required nor does any patient show any aspiration. Because of a low-flow resistance of the shunt, patients so treated possess long-lasting phonation with loud and modulated voices.

Survival of a free musculocutaneous flap after early loss of arterial blood supply

A 30 X 15 cm free musculocutaneous flap survived nearly completely when its supplying artery was ligated on the 17th postoperative day to control bleeding from a ruptured septic aneurysm. Similar cases in the literature are reviewed and the factors influencing flap survival are discussed.

Untersuchungen zur mechanischen Aktivität frei transplantierter Dünndarmabschnitte beim Hund

ZusammenfassungNach freier Transplantation einer Dünndarmschlinge bei 6 Hunden wurden im Wachzustand die intraluminalen Druckschwankungen registriert. Dabei konnten die für den Dünndarm typischen Aktivitätsmuster, weiters eine zeitliche Koppelung der segmentären Kontraktionen sowie Unterschiede zwischen dem nüchternen Tier und nach Fütterung festgestellt werden.SummaryAfter free transplantation of a small bowel-loop intraluminal pressure recordings have been performed in six unanesthesized dogs. The typical activity pattern of the small bowel, a close temporal correlation between the segmental contractions and the differences of the digestive and interdigestive state could be observed.

Radiation of jejunal interposition in T3–T4 upper aerodigestive tumours

30 patients with T3 and T4 tumours of the upper aerodigestive tract had their tumours resected by pharyngolaryngectomy. This was followed by reconstruction of a gullet or creation of a siphon as a tracheohypopharyngeal shunt for voice restoration with a free jejunal autograft. All patients were treated postoperatively with 60Co gamma radiation, 6 MeV photons or 7.5 to 10 MeV electrons of a beta-tron, with a dose of 50-65 Gy in the area of the primary tumour and 50-65 Gy to the neck. 4 patients refused further treatment after a depth dose of between 16 and 32 Gy. Local recurrence occurred in 40% of cases. The survival rate was 36.6% (11/30) after a mean follow-up time of 21.5 months, although 2 patients died of intercurrent diseases without recurrence of their tumours. The results obtained justify active surgical intervention with postoperative irradiation even at an advanced stage of the tumour.

Autotransplanted Jejunum in Patients with Carcinomas of the Head and Neck: Transport of Immunosurveillance against Tumor Cells?

Autologous jejunum, transplanted as a functional replacement immediately after radical dissection of advanced stages of squamous cell carcinomas of the head and neck and subsequently irradiated, was examined by immunohistochemistry (APAAP/PAP-technique). Biopsies from 9 patients were taken at the time of transplantation and up to 24 months thereafter (group 1) and from 5 patients only once after transplantation (group 2). Twenty-six monoclonal antibodies (mAbs) were used as surface markers to give an overview about phenotypical changes with respect to T-, B- and M phi-antigens. 1) B cells: a general increase of CR2+ (CD21, p less than 0.01) could be noticed after transplantation, immunoglobulin positive cells remained unchanged expect for a significant decrease of IgM+ (p less than 0.01) and IgA1+ (p less than 0.01) cells. 2) The number of T cells (CD3+) showed no significant differences although TcR gamma/delta+ cells decreased (p less than 0.01) in the autotransplant. ICAM-1 (CD54) and IL-2R (CD25) were found on a significant (p less than 0.01) higher number of cells after transplantation. 3) Cells with M/M phi morphology showed increased expression of the Fc gamma receptors (CD64, p less than 0.001; CD32, n.s.; CD16, p less than 0.001), of the complement receptors CR1 (CD35, (p less than 0.001) and CR3 (CD11b, p less than 0.02), of HLA-DQ (p less than 0.01), and of the antigens 25F9 (mature M phi; p less than 0.01) and CD4 (p less than 0.02). Correlation analyses of data obtained from the biopsies of the 14 autotransplanted jejunum cases revealed a CD35+ and a 25F9+ subpopulation of M/M phi. Our findings indicate that despite irradiation autotransplanted jejunum contained cells with immunological capacities. Therefore, the replacement of larynx by autologous jejunum may facilitate not only mechanical but also immunological functions.

Reconstruction of the Pharynx and the Cervical Esophagus with Free Transplanted Jejunum

“No resection without reconstruction” — this slogan seems to have special significance for surgery in the pharyngoesophageal area. The capacity to swallow has to be reinstated but it is no less important to restore the patient’s ability to speak. Different possibilities of reconstruction are available. In the past few years grafting of segments of the intestine followed by vascular anastomosis has been used increasingly.

Hypopharynxrekonstruktion mit frei transplantiertem Jejunum

Wir berichten uber die Schluckfunktion von 39 Patienten, bei denen die Hypopharynxvorderwand (n = 21) oder der komplette Hypopharynxschlauch (n = 18) mittels frei transplantiertem Jejunum rekonstruiert wurde. Diese Defekte der Schluckwege entstanden bei 29 Patienten nach Tumorresektion wegen eines ausgedehnten Plattenepithelkarzinoms in Hypopharynx, bei 7 Patienten nach Resektion eines Lokalrezidivs nach Operation und Radiatio eines Larynxkarzinoms, bei 2 Patienten nach Resektion einer Stenose im Hypopharynx nach Laryngektomie und Bestrahlung und bei einem Patienten wurde ein in den Laryngopharnyx infiltrierndes Karzinom der Schilddruse entfernt.

19. Ein neues Verfahren zur Wiederherstellung der Stimme — Die Neoglottis aus Dünndarm

The fundamental concept in vocal rehabilitation after laryngectomy is the tracheo-hypopharyngeal shunt. The usual contemporary methods possess numerous disadvantages. In order to improve the results a syphon-fashioned shunt with free transplanted jejunum between the tracheal stump and the hypopharynx is created (stimulated by K. Ehrenberger). Aspiration can be avoided by means of the autonomic peristalsis of the implant. The procedure has been performed in 7 cases. One developed necrosis of the loop. The other patients possess a clear voice.SummaryThe fundamental concept in vocal rehabilitation after laryngectomy is the tracheo-hypopharyngeal shunt. The usual contemporary methods possess numerous disadvantages. In order to improve the results a syphon-fashioned shunt with free transplanted jejunum between the tracheal stump and the hypopharynx is created (stimulated by K. Ehrenberger). Aspiration can be avoided by means of the autonomic peristalsis of the implant. The procedure has been performed in 7 cases. One developed necrosis of the loop. The other patients posses a clear voice.ZusammenfassungDas bedeutendste Konzept zur Wiederherstellung der Stimme nach Laryngektomie ist die tracheo-hypopharyngeale Shuntbildung. Die derzeit üblichen Methoden haben zahlreiche Nachteile. Zur Verbesserung der Ergebnisse wurde (nach Anregung von K. Ehrenberger) aus frei transplantiertem Jejunum ein syphonartiger Shunt zwischen Trachealstumpf und Hypopharynx hergestellt. Die Aspiration wird durch die autonome Peristaltik des Jejunums verhindert. Das Verfahren wurde bei 7 Fällen durchgeführt. Einmal kam es zur Nekrose, die anderen Patienten besitzen eine verständliche Stimme.