1/5. Prefabrication of jejunum for challenging reconstruction of cervical esophagus.A significant benefit exists for a jejunal replacement of the cervical esophagus, if indicated. The absence of available recipient vessels may impede free tissue transfer. If vascular induction between a vascular carrier and the selected jejunal segment is done as a kind of flap prefabrication, the jejunal interposition flap can be used without the need for complex microsurgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. Ileal pedicle grafting for esophageal replacement in children.Reconstruction of the upper esophagus in small children remains a challenge. Free jejunal interposition as frequently used in adults is much less appropriate in children because of the limited vessel size. The use of a jejunal pedicle graft in children has been described, but gaining enough length may be a problem. A pedicle graft of terminal ileum may be a better option, but this technique has never been described. We report a child with esophageal atresia and distal fistula who had a very short upper esophageal pouch. Primary repair was impossible. The fistula was ligated and a gastrostomy created. A second attempt at anastomosis was not successful either, and a cervical esophagostomy was created. The child was fed by gastrostomy and received sham feeding orally. When the child was 10 months old, the upper esophagus was successfully reconstructed with a pedicle graft of terminal ileum. Postoperatively there was a limited leak of the proximal anastomosis, which healed spontaneously. The distal anastomosis had to be dilated on a few occasions. With a follow-up of 1 year, the child is eating well without gastrostomy supplementation. On imaging, the ileal pedicle graft looks somewhat tortuous but contracts nicely. We feel that ileal pedicle graft reconstruction of the esophagus should be part of the instrumentarium of pediatric surgeons dealing with esophageal reconstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/5. Double aortic arch associated with esophageal atresia and tracheoesophageal fistula.esophageal atresia (EA) with tracheoesophageal fistula (TEF) is commonly associated with significant cardiovascular anomalies. mortality is higher with cardiovascular abnormalities, especially those undiagnosed prior to surgical repair of the EA/TEF. Advances in cardiac imaging techniques, most notably echocardiography, have made noninvasive evaluation of the heart and great vessels easy to perform and reliable. Thus, the preoperative cardiovascular anatomy of these infants should be routinely assessed prior to surgical correction. A case of EA/TEF associated with an unsuspected double aortic arch is described. Although a wide variety of cardiovascular lesions have been associated with EA/TEF, coexistence of a double aortic arch has not been previously reported. Preoperative recognition of this anomaly would have altered the surgical approach, and perhaps reduced the postoperative morbidity and mortality.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/5. tracheoesophageal fistula and anomalies of thoracic vessels: their occurrence in a case of congenital rubella.Virologic, gross, and microscopic studies of rubella embryopathy were performed. The presence of esophageal atresia with tracheal fistula allied with anomalies of the thoracic vessels were seen. We believe that both the mechanical action of the anomalous vessels on the developing organ, and the vascular degenerative aortic lesions, which are identical to those described in rubella syndrome, are probable causes of the esophageal malformation.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
5/5. Congenital triangular alopecia.We report a child with bilateral congenital triangular alopecia. Shaving the scalp and inserting intravenous cannulas into scalp vessels during the neonatal period was misconstrued by the parents as the cause of hair loss, and resulted in medicolegal implications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |