Gross morphologic and functional effects of postoperative radiation on free jejunal autografts

Abstract

Twenty adult mongrel dogs underwent free jejunal transplants to the neck; 10 either died of or had to be sacrificed as a result of postoperative complications, 5 received a 55-Gy-equivalent dose of radiation after 3 weeks, and 5 were followed as controls. Serial manometric and endoscopic evaluations were performed over a 9-month period. Progressive deterioration of the quality and amplitude of peristalsis of the jejunal autografts was observed only in the radiated group. In addition, all dogs in the radiated group developed severe jejunal circumferential constriction and stricture formation. These delayed effects of irradiation on revascularized jejunal autografts should be considered in planning the method of pharyngoesophageal reconstruction as well as the timing of adjuvant radiotherapy.

Jejunum interposition after cervical esophageal resection*

“…The only histologic changes observed after radiotherapy were flattening and broadening of the intestinal villi and a slight infiltration of the submucosal layer with chronic inflammatory round cells, whereas the structure of the columnar epithelium stayed almost unchanged. Similar observations have been reported by several authors 5 , 15–18 , 24 …”

Advantages and limitations of free and pedicled flaps in reconstruction of pharyngoesophageal defects

“…Lower adjuvant doses have been shown to adversely affect oncologic control [63]. Yet jejunal grafts have been shown to have a higher tolerance than small intestine in the abdomen, and as such, the presence of a free jejunal reconstruction does not require a reduction postoperative radiotherapy [64][65][66][67].…”

Autonomization of free flaps in the oral cavity: A prospective clinical study

“…The risk for a late flap failure if it is entirely pedicle dependent is especially evident in the head and neck, were its blood supply can be disrupted by secondary salvage surgery for late lymph node metastases or tumor recurrence. The assumption that irradiation leads to slower neovascularization further increases the uncertainty about secondary procedures involving the flap 6, 7. Currently, no prospective study is available that describes neovascularization of intraoral free flaps.…”