Reconstruction of the hypopharynx with the free jejunum transfer.
Microsurgical techniques have revolutionized pharyngolaryngeal reconstruction. Free flap reconstruction with the free jejunal flap enables one stage reconstruction with minimal morbidity and mortality. This review will examine indications, operative technique, postoperative management, and expected outcomes for the hypopharyngeal reconstruction with the free jejunum flap. This procedure allows for maintenance of oral sections and rapid return of per-oral feeds and swallowing. The vast majority of patients resume swallowing and can maintain adequate nutrition without the need for supplemental enteral feeding via a tube. The free jejunal transfer can be rapidly harvested in most instances and transplanted to the hypopharyngeal region with a greater than 95% success rate. The jejunum fee flap is most useful for circumferential defects of the hypopharynx, but can also be used for partial defects. The most common local complications are stricture and fistula formation. A history of preoperative radiation therapy increases the risk of local complications.
Disa
Joseph J
JJ
Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. disaj@mskcc.org
Pusic
Andrea L
AL
Mehrara
Babak J
BJ
D000075202:Contraindications; D006801:Humans; D007013:Hypopharynx / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation*; D008866:Microsurgery; D008991:Monitoring, Physiologic; D011182:Postoperative Care; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome