Six patients with
esophageal stenosis and nine patients (13 hands) with
hand deformity (contracted fingers, mitten-like
deformity) were treated surgically after
anemia and
malnutrition were corrected by intravenous
iron infusion, high-energy diet, and
blood transfusion. As intubation was contraindicated, topical
anesthesia was used (eg.,
lidocaine spray to the nasopharyngeal mucosa for esophageal dilatation and brachial block,
ketamine drip, and
nitrous oxide inhalation for reconstruction of contracted fingers). We established a new method for esophageal dilatation using a microvasive rigiflex balloon
catheter. This
catheter was advanced to the stenotic area under radiography and then expanded by injecting contrast medium into the balloon. For reconstruction of
hand deformities, the epidermal glove was initially peeled off, and then the combined digits separated carefully by hand. If the release of the
contracture was not sufficient, a skin incision was made avoiding injury to nerves and blood vessels. Any skin defects that appeared after the release of the
contracture were covered with skin grafts taken from the abdominal wall. K-wire fixation was used to maintain the extended position of the fingers. Three weeks after the operation, the K-wires were removed and rehabilitation was commenced.
RESULTS: The
esophageal stenosis was successfully dilated with the balloon
catheter; in all six cases the
dysphagia was relieved immediately. There was no recurrence in any of the patients on long-term follow-up. After reconstruction of the hand, daily activity improved in 12 of the 13 hands. The remaining hand was difficult to reconstruct due to severe mutilation and bone
deformity. During follow-up, 6 of the 12 hands maintained successful reconstruction, whereas the remaining 6 hands showed slight to moderate recontraction of the fingers.
CONCLUSION: Esophageal dilatation with a balloon
catheter is safer and has fewer side effects compared to other
surgical procedures. This method can provide favorable results and can be carried out repeatedly in a short time. Daily and social activities of patients can be improved upon reconstruction of
hand deformities.