title: Double vascular anastomosis for safer free jejunal transfer in unfavorable conditions.
abstract: Free jejunum was transferred to a patient with recurrent hypopharyngeal carcinoma under unfavorable cervical conditions, caused by prior therapeutic chemoradiotherapy for hypopharyngeal carcinoma and gastric pull-up with cervical leak, resulting from treatment for thoracic esophageal cancer. The cervical recipient vessels were buried in extensively scarred fibrous tissues, so they were thought to be less reliable. Because postoperative vascular occlusion was anticipated, in addition to the ordinary single vascular anastomosis to the damaged cervical vessels, secondary vascular anastomosis to the healthy chest vessels was performed. We designed the graft to have double vascular pedicles that communicated with each other through arcade vessels. This made it possible to anastomose doubly to an intact thoracoacromial artery in the chest by elongating the vascular pedicles of the mesentery without the need for an interpositional vein graft, in addition to ordinary anastomosis in the damaged neck. The flap is nourished by the vessels from two different origins (carotid and axillary arteries, internal jugular and axillary veins) at two different places (damaged and healthy areas). This method increases the quantity of feeding vessels while improving the quality of the recipient vessels within the local area and flow sources. It is one treatment option when conditions are unfavorable for safer jejunal transfer.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. prs-bin@koto.kpu-m.ac.jp
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Numajiri
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nishino
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sowa
authors.forename: Maki
authors.initials: M
authors.lastname: Uenaka
authors.forename: Shidu
authors.initials: S
authors.lastname: Masuda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakai
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hisa
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007583:Jejunum / Q000098:blood supply / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures / Q000379:methods*