A Reliable Method for Monitoring the Microvascular Patency of Free Jejunal Transfers in Reconstructing the Pharynx and Cervical Esophagus

Bafitis, Harold; Stallings, James O.; Ban, Justin L.

doi:10.1097/00006534-198905000-00024

Cited by 28 publications

(17 citation statements)

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“…This was shown to be unsatisfactory, due to accumulation of blood and serum between the window and serosa, predisposing the flap to infection and necessitating closure of the window secondarily 11. Instead, Bafitis and associates covered the surgical window with a split‐thickness skin graft 12. This method was also proven inadequate because of a poor cosmetic result and permanent soft‐tissue defect 8.…”

Section: Discussionmentioning

confidence: 99%

Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases

et al. 2012

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Objectives/Hypothesis: The free jejunum transfer has become a widely used reconstruction option after total laryngopharyngectomy. The aim of this study was to evaluate the effectiveness of using an exteriorized jejunal segment for flap monitoring.Study Design: Case series. Methods: Twenty patients with tumors involving the pharynx, larynx, or cervical esophagus were subjected to total laryngopharyngectomy and neck dissection. The resulting esophageal defect was reconstructed with a free jejunal flap based on a major branch of the superior mesenteric artery and vein. After completion of anastomoses with the recipient vessels, the flap was divided into two segments of common vascular supply. The smaller segment was exteriorized in the cervical region for direct monitoring of serosal color, temperature, peristalsis, and bleeding during the postoperative period. This sentinel was resected once the viability of the flap was judged appropriate.Results: Of the 20 patients who had free jejunum transfers for pharyngoesophageal reconstruction, 14 had an uneventful postoperative course, and six needed re-exploration due to signs of arterial insufficiency in the sentinel segment. On re-exploration, four flaps were found to have arterial thrombosis and two had no abnormality at the anastomotic site. One of the flaps that developed thrombosis was subsequently lost.Conclusions: Monitoring of buried free jejunal flap with a sentinel is an effective method of assessing flap viability after total laryngopharyngectomy and guides re-exploration in cases of anastomotic complications.

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Section: Discussionmentioning

confidence: 99%

Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases

et al. 2012

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“…Direct visualisation methods include observation through the mouth using a fibre optic pharyngoscope, through a Silastic Ò window placed in the neck flap [23], or through a surgical window on the anterior cervical flap covered by a thin skin graft [14]. Indirect monitoring methods include the use of a buried monitor probe, external surface monitoring with an ultrasonic Doppler [24], application of a monitoring flap using an isolated segment of the jejunum supplied by the same vascular pedicle [15,25], intramucosal PCO 2 measurement [21], or tonometric pHi monitoring [22].…”

Section: Discussionmentioning

confidence: 99%

“…Direct visualisation through a Silastic Ò window also has its shortcomings, including impaired visualisation due to an accumulation of blood or serum between the window and the serosa and an inability to assess bleeding and peristalsis [23]. Bafitis et al [14] introduced a method of creating a surgical window on the cervical flap that was covered by a thin skin graft. The disadvantages of this method are a poor cosmetic result and a permanent soft-tissue defect in the anterior of the neck.…”

Section: Discussionmentioning

confidence: 99%

“…Because direct visual inspection is impossible due to the lack of an external component, practical bedside monitoring of the buried free jejunum flap is limited to only a few devices [6,13]. Using a laryngeal fiberscope, creating a surgical window [14], or externalising an indicator segment [15,16] allows for direct observation of peristalsis and mucosal or serosal colour. Indirect monitoring methods include the use of implantable and handheld Dopplers [17][18][19][20], intramucosal PCO 2 measurement [21] and tonometric pHi monitoring [22].…”

Section: Introductionmentioning

confidence: 99%

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A “watch window” technique for monitoring buried free jejunum flaps during circumferential pharyngolaryngectomy reconstruction

Zhang

Liu

et al. 2011

Eur Arch Otorhinolaryngol

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The free jejunum flap approach is the optimal option for circumferential pharyngolaryngectomy reconstruction. In this study, we designed a "watch window" for monitoring buried free jejunum flaps, thereby allowing us to assess graft viability. From 2007 to 2011, 14 patients with hypopharyngeal cancer underwent circumferential pharyngolaryngectomy that was reconstructed using a free jejunum flap at the Sun Yat-sen University Cancer Centre. During the closing of the neck incision, a "watch window" was designed for postoperative monitoring. Two patients experienced thrombosis of the pedicle. One was detected early and successfully rescued by removal of the thrombosis, the other one managed with a second free jejunum flap. The success rate of the buried flaps was 92.9%. No pharyngocutaneous fistulas or strictures occurred. All patients eventually resumed oral feeding and swallowing. The "watch window" technique for monitoring buried free jejunum flaps is simple, reliable and useful for finding vascular problems. Level of evidence Case series.

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“…Several publications describe modified clinical monitoring methods by the use of an opening in the front of the neck region for inspection of the auto-SBT either directly, as described by Bootz and Müller [12], through a silastic sheeting, as described by Hester et al [13], or through a split-skin transplant, as described by Bafitis et al [14]. Skepticism regarding reliability and efficacy is even more pronounced using this method, as sensitivity is impaired due to fibrin and slough adhering to the exposed raw surface.…”

Section: Direct and Indirect Visualizationmentioning

confidence: 99%

Detection of Postoperative Intestinal Ischemia in Small Bowel Transplants

Birke-Sørensen

2012

Journal of Transplantation

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Small bowel transplantation is acknowledged as auto- and allotransplantation. In both instances, there is up to a 4%–10% risk of postoperative ischemia, and as the small bowel is extremely susceptible to ischemia, the timely diagnosis of ischemia is important. The location of the transplant, whether it is buried in the abdominal cavity or in the neck region, increases the challenge, as monitoring becomes more difficult and the consequences of neglect more dangerous. All methods for the early detection of postoperative ischemia in small bowel transplants are described together with the requirements of the ideal monitoring method. A small bowel transplant can be inspected directly or indirectly; the blood flow can be monitored by Doppler or by photoplethysmography, and the consequences of the blood flow can be monitored. The ideal monitoring method should be reliable, fast, minimally invasive, safe, objective, easy, cheap, and comfortable. No monitoring methods today fulfill the criteria of the ideal monitoring method, and evidence-based guidelines regarding postoperative monitoring cannot be made. The choice of whether to implement monitoring of ischemia—and if so, which method to choose—has to be made by the individual surgeon or center.

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A Reliable Method for Monitoring the Microvascular Patency of Free Jejunal Transfers in Reconstructing the Pharynx and Cervical Esophagus

Cited by 28 publications

References 0 publications

Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases

Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases

A “watch window” technique for monitoring buried free jejunum flaps during circumferential pharyngolaryngectomy reconstruction

Detection of Postoperative Intestinal Ischemia in Small Bowel Transplants

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