Free jejunal flap transfer with multiple vascular pedicles for safe and reliable pharyngoesophageal reconstruction

Abstract

BACKGROUND: In pharyngoesophageal reconstruction, we transferred a long jejunum flap containing multiple pedicles to achieve a 100% flap survival rate, and used the redundant mesentery to cover important tissues and fill in the dead space to reduce common postoperative complications, such as surgical site infections and fistula formation. METHODS: A total of 243 jejunal flap transfers with multiple vascular anastomoses were reviewed to examine flap survival and rates of early postoperative complications, such as surgical site infections and fistula formation, perioperative mortality, and donor site morbidity. RESULTS: All 243 jejunal flaps survived without any partial necrosis. The surgical site infections occurred in 15 cases (6.2%) and fistula formation in 9 cases (3.7%). The perioperative mortality rate was 0.4%. There were 7 cases (2.9%) with donor site morbidity. CONCLUSION: Although our procedure requires extra operating time for additional vessel anastomoses, it could be performed safely and reliably with a high success rate.