Double Arterialized Free Jejunal Flap

Abstract

In a standard free jejunal transfer, one artery and one vein are anastomosed. However, when raising the jejunal flap, a one-segment jejunum sometimes has two arteries and one accompanying vein as a vascular pedicle. Free jejunal transfer in which two arteries and one vein are anastomosed was designed. We report on the safety and advantages of using this artery-dominant transfer when performing microvascular anastomosis. This technique was used when a one-segment jejunum had two arteries and an accompanying vein. Eight patients underwent this arterial-supercharged free jejunal transfer. All flaps survived, and no complications developed except for two cases of intraoperative thrombosis before the procedure. It is important to transfer the artery-rich graft into the same physiological environment by reconstructing the similar hemodynamics. The grafts can be transferred without harm. This artery-dominant method can be an option when conditions are unfavorable for safer jejunal transfer.

Free Jejunal Graft Repair after PharyngoLaryngo-Esophagectomy-Risk Factor Analysis for Postoperative Dysphagia

“…Decreased blood flow on recipient artery such as TCA after radiation may lead graft ischemia which resulting in impaired peristalsis. Numajiri, et al 10) advocated the use of two or more recipient artery to donor artery of FJG to increase graft blood flow. A double arterialized free jejunal graft might reduce the risk of venous thrombosis and increase the peristaltic motion which might be a possible countermeasure.…”

Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction

“…Arterial augmentation also shows efficacy for reduced flap necrosis [ 34 – 36 ]. Some animal studies have demonstrated that arterial supercharging is more important for flap viability than venous superdrainage [ 37 , 38 ].…”

Does a vascular supercharge improve the clinical outcome for free jejunal transfer?

“…In addition to these advantages from providing an improvement of blood circulation, a supercharged free flap has another benefit. Because dual vascular anastomoses are used, even if one anastomosis is thrombosed, total flap necrosis can be avoided because the other anastomosis should remain patent 5–7…”

“…Augmentation of the vasculature is believed to extend the territory nourished within the flap. A supercharge is rarely applied to free flaps; however, we performed a supercharge in a free jejunal transfer for hypopharyngeal and cervical esophageal reconstruction, because if one anastomosis is obstructed by a thrombus, another vascular anastomosis can function as a backup supply for flap survival 5–7…”