January 6, 2010
Tulane University surgeons have developed a new, less-invasive procedure to preserve speech and swallowing functions in patients being treated for head and neck cancers.
Dr. Ernest Chiu, associate professor and director of plastic surgical research, and Dr. Paul Friedlander, chairman of Otolaryngology, Head and Neck Surgery, have developed a surgical technique which uses a small blood vessel within a flap of skin from the shoulder to reconstruct the pharyngeal and esophageal lining of patients who have had a significant portion of their neck and larynx removed in cancer treatment. Without restoration of this critical anatomical area, patients are unable to swallow or speak.
Typically, surgeries following treatment for these types of cancers use the patient’s own tissue transplanted from the small intestine, arm or leg to reconstruct the pharyngoesophagus.
Traditional techniques are much more invasive and carry higher risks of complications, Chiu says. The new technique reduces surgery time by up to 40 percent, results in faster recovery and restores swallowing function in two to three weeks. A quicker recovery allows patients to continue additional cancer treatment therapies more rapidly. Patients are also eligible for placement of a prosthesis that can preserve speech function without having to use an electro larynx, which is a medical device patients touch to their neck to speak.
"This new surgical approach offers patients an alternative reconstructive surgery technique that is safe and less invasive without the longer operative and recovery time in traditional free tissue transplant techniques,” says Chiu, who has performed the technique since 2007.
Chiu details his results in an article entitled "Circumferential Pharyngoesophageal Reconstruction Using Supraclavicular Artery Island Flap," which appears in the January 2010 issue of Plastic & Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons. Friedlander is co-author of the article along with four other Tulane doctors. A copy of the article is available online here.
Chiu is an expert in facial aesthetic and reconstructive surgery, and has been invited to present his surgery technique at both national and international meetings as well as at leading cancer treatment centers. Each year, 75,000 new cases of head and neck cancers are diagnosed in the United States. Laryngeal and pharyngeal cancers represent approximately 20 percent of new cases annually.
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