Journal of Plastic, Reconstructive & Aesthetic Surgery
Dysphagia after an L-shaped reconstruction technique of the free jejunum graft
Section snippets
Materials and methods
Between January 1990 and April 2008, 51 patients were treated at the Erasmus Medical Center for malignant tumours of the larynx, hypopharynx, oropharynx or cervical oesophagus with a jejunum interposition. A total laryngopharyngectomy was performed, followed by a jejunum interposition using an L-shaped side-to-end anastomosis in the last six consecutive patients. In these six patients, the patient history and demographics; tumour stage and location; and previous and adjuvant treatment were
Results
A successful jejunum transfer was performed in all six patients treated with an L-shaped anastomosis. The median duration of the operation was 410 min (range: 313–440 min) and the median hospital stay was 16 days (range: 10–83 days). No flap failure occurred, but one patient had abdominal complications due to an enterocutaneous fistula, which required three abdominal surgical procedures. In a second patient, multiple intra-abdominal serosa lesions and abdominal dehiscence developed, which
Discussion
Reconstruction of defects after resection of extensive tumours in the laryngopharyngeal region and cervical oesophagus remains a surgical challenge. The development of a surgical technique that adequately manages the mismatch between the lumen of the oropharynx and the transferred graft to prevent stricture resulting in dysphagia without an increased risk of pharyngocutaneous fistula formation has been subject to debate for a long time.13, 14, 15, 16, 17, 18, 19, 20
Since the prognosis of
Financial disclosure
No financial conflicts reported.
Conflict of interest
None.
References (23)
- et al.
Chemotherapy added to loco-regional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer
Lancet
(2000) - et al.
Ann Chir
(2002) - et al.
Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James's experience
J Plast Reconstr Aesthet Surg
(2007) - et al.
Reconstruction of cervical oesophagus with free double-folded intestinal graft
Br J Plast Surg.
(1985) - et al.
Expansion of the oral end of free revascularised jejunum with a jejunal patch flap rotated like a folding fan
Br J Plast Surg.
(1998) - et al.
Double lumen free jejunal transfer for reconstruction of the entire floor of mouth, pharynx and cervical oesophagus
Br J Plast Surg.
(1991) - et al.
Long-term quality of life after total laryngectomy and postoperative radiotherapy versus concurrent chemoradiotherapy for laryngeal preservation
Laryngoscope
(2008) - et al.
Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases
Arch Surg
(2001) - et al.
Free jejunal autograft reconstruction after total pharyngolaryngeal resection
Int Surg
(2006) - et al.
Surgical treatment and clinical course of patients with hypopharyngeal carcinoma
Dis Esophagus
(2006)
Reconstruction of the cervical esophagus: free jejunal transfer versus gastric pull-up
Plast Reconstr Surg
Cited by (2)
Reconstruction of hypopharyngeal and cervical esophageal defect
2015, Otolaryngology - Head and Neck Surgery (Japan)Free jejunal graft repair after pharyngo-laryngo-esophagectomy-risk factor analysis for postoperative dysphagia
2014, Annals of Thoracic and Cardiovascular Surgery