Free jejunum transfer for hypopharyngeal reconstruction : technical aspects and outcome

الملخص EN

Background : The free jejunal flap is rapidly evolving as a preferred method for restoration of upper digestive tract continuity following total laryngopharyngectomy.

Our experience with the technique is reported.

Material and methods : Twenty-two patients with hy-popharyngeal cancer were included in the study period October 1996-December 2000.

There were 20 males and two females with average age of 45 years.

Total laryngopha-ryngectomy with neck dissection was carried out for all patients.

Transfer of a jejunal segment to neck with micro-vascular technique was used for reconstruction.

All patients received postoperative radiation therapy.

Results : average operation time was 5 hours with estimated blood loss of 800 cc.

Ischemia time ranged between 40-130 minutes.

Two cases (9 %) died in the immediate postoperative period (reactionary hemorrhage and systemic sepsis following flap loss).

Five patients developed complications (27 %) ; flap loss in two patients and salivary fistula in three patients that closed on conservative treatment.

Overall success rate was 88% (18 / 22).

For successful cases, swallowing was resumed on post-operative day 7.

All patients tolerated radiation therapy well.

Conclusion : Free jejunal flap is a dependable one stage procedure that will restore gastrointestinal continuity.

The mucosal lined flap represents an excellent anatomic and physiologic replacement for the hypopharynx.