Standardization of Free Jejunum Transfer After Total Pharyngolaryngoesophagectomy

Abstract

Our latest method of free jejunum transfer reconstruction has become reliable and expeditious through simple and stable minor revisions of procedures.

Comparison of salvage and planned pharyngolaryngectomy with jejunal transfer for hypopharyngeal carcinoma after chemoradiotherapy

“…Although they were deprived of their own speech after pharyngolaryngectomy, all of them were satisfied with the surgical outcomes because they could resume oral intake. Free jejunal flaps are well vascularized and reported to have a low risk of morbidity, including leakages, so they can restore the ability of oral intake as early as possible 10. Therefore, the current results suggest jejunal transfer after salvage pharyngolaryngectomy to be an excellent choice of treatment for restoring oral intake as early as possible and for improving the quality of life in patients with recurrent hypopharyngeal carcinoma.…”

“…There are various choices of reconstruction: by pedicled flaps such as deltopectoral flaps or pectoralis major musculocutaneous flaps, and free flaps such as radial forearm flaps, anterolateral thigh flaps, or jejunal flaps. Among them, free jejunal transfer is our first choice because of its low risk of perioperative complications and earlier achievement of oral intake 10. For patients with previously irradiated neck, however, free tissue transfer should be performed carefully because of the damage to the recipient vessels and the delayed wound healing.…”

Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects

“…In particular, free jejunal transposition is frequently associated with postoperative ileus, potentially leading to major complications, prolonged recovery, and longer hospital stay. In this view, although functional results are, in the best case scenario, comparable with those obtained using fasciocutaneous free flaps, there is a higher perioperative mortality frequently related to abdominal complications, even when considering large series of patients . On the other hand, pedicled flaps such as the PMMC are more suited as an alternative to free flaps in patients with general or local contraindications for microsurgery .…”

“…Currently, fasciocutaneous free flaps, in particular radial forearm (RF) and anterolateral thigh (ALT), are considered among the main options for such a reconstructive purpose, especially considering the high rates of PCF and stenosis generally observed after pectoralis major myocutaneous (PMMC) pedicled flap, and the non‐negligible complication rate associated with a jejunum free flap …”

Evaluation of routine contrast swallow following total pharyngolaryngectomy and free jejunal transfer

“…The incidence of anastomotic leakage following TPL and FJT has been reported to vary from 5.1 to 32.6% . Routine screening of anastomotic leakage using contrast swallow is widely performed before oral intake.…”