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Journal of the Korean Cleft Palate-Craniofacial Association 2008;9(2):110-113.
Pharyngoesophageal Reconstruction Using Modified Jejunomesenteric Composite Free Flap.
Jin Soo Lim, Gyeol Yoo
Department of Plastic Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea. psyg@catholic.ac.kr
Abstract
PURPOSE
The jejunal free flap is the most standard and reliable procedure of reconstruction of the circumferential pharyngoesophageal defect because it provides pliable, elastic, secreting mucosa and posses reliable vascular anatomy. In this report, the authors introduce the modification of jejunal free flap for decreasing the complications in fatty complicated patients. METHOD: After harvesting the jejunum with mesentery and mesenteric vessels, both ends of jejunum were excised remaining the mesenteric portion. The jejunal portion of this composite flap was placed to reconstruct esophagopharyngeal defect area and the mesenteric portion was used to obliterate the dead space at paratracheal region and to cover the vital structure and the vascular anastomotic region. RESULT: A 72 year-old man with recurrent hypopharyngeal cancer who had about 15cm sized circumferential pharyngoesophageal defect after total pharyngectomy was reconstructed with jejunomesenteric composite free flap without any complications.
CONCLUSION
The mesenteric flaps at both side of jejunomesenteric composite free flap provide the advantages that could obliterate dead space, that could provide cover for the vital cervical vascular structure in case of vascularity was compromised due to previous radiation therapy, and that could preserve as much vascularity at both ends of jejunal flap as possible.
Keywords: Pharyngoesophageal defect; Jejunal free flap


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