title: Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James's experience.
abstract: Surgical treatment of hypopharyngeal cancers with extension to the postcricoid region generally requires a circumferential pharyngolaryngoesphagectomy followed by reconstruction of the upper aerodigestive tract. Many techniques have been described in order to achieve a safe and functional reconstruction. Interposition of the jejunal free flap (JFF) is a well-established technique and is the flap of choice in our unit. This is a retrospective review of all patients who required a JFF following pharyngolaryngoesphagectomy over an 9-year period. We studied medical charts, histological reports, and speech and language therapy assessments. Eight of the nine surviving patients completed a quality of life questionnaire. Analysis was carried out on patient demographics, flap survival, patient survival and quality of life including swallow function and speech restoration. A total of 23 patients had 24 jejunal free flaps. There were four perioperative deaths. Two flaps failed, and were salvaged with a second JFF in one case and a gastric pull-up in the second. Functioning swallow was established in 74% of patients with four patients complaining of dysphagia. Speech was restored using an electrolarynx or Blom Singer valve in 70% of patients. Most patients required radiotherapy as part of their adjuvant treatment. In our hands the JFF for reconstruction following pharyngolaryngoesophageal resection allows restoration of function following major ablative surgery.
authors.affiliation: Plastic and Reconstructive Department, St James's Hospital, St James's Gate, Dublin 8, Ireland. rhanson@eircom.net
authors.forename: R P
authors.initials: RP
authors.lastname: Hanson
authors.forename: T K
authors.initials: TK
authors.lastname: Chow
authors.forename: E
authors.initials: E
authors.lastname: Feehan
authors.forename: P A
authors.initials: PA
authors.lastname: Eadie
authors.forename: C T
authors.initials: CT
authors.lastname: Timon
authors.forename: S
authors.initials: S
authors.lastname: Keogh
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000503:physiopathology / Q000601:surgery*; D003679:Deglutition / Q000502:physiology; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D007583:Jejunum; D007825:Laryngectomy / Q000379:methods; D007830:Larynx / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000379:methods; D010614:Pharynx / Q000601:surgery; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome