Salvage or what follows the failure of a free jejunum transfer for reconstruction of the hypopharynx?
OBJECTIVE
To analyse the cases of failure of free jejunum transfer with subsequent secondary reconstruction methods after ablative surgery for malignant tumours of the laryngopharyngeal region and the cervical oesophagus with reconstruction using a jejunum interposition.


METHODS
Four cases in which failure of the jejunum interposition was managed with a second free or pedicle transfer were identified. The electronic files of patients were studied and analysed for patient characteristics and failure of reconstruction; type of salvage surgery and outcome; swallowing function and rehabilitation; postoperative complications; recurrence of tumour; patient survival and cause of death.


RESULTS
Failure of the interposition occurred within 11 days in all patients, with oral bleeding being the most prominent sign. To replace the failed jejunum transfer, two new free jejunum transfers, two gastric pull-ups and one colon interposition after the second failure of a jejunum transfer were used. Three patients started swallowing rehabilitation, of which two achieved complete oral intake, defined as the redundancy of a feeding tube. The median disease-free period and overall survival was 28 and 42 months, respectively.


CONCLUSIONS
Failure of a free jejunum transfer is a rare but inevitable complication when performed in a high-risk patient population, with oral bleeding being the most important sign of necrosis. Salvage of the buried jejunum interposition is hardly ever possible and secondary reconstruction can be performed using a new jejunum interposition or gastric pull-up procedure with considerable early postoperative complications, but relatively good results regarding swallowing rehabilitation and patient survival.
Department of Head and Neck surgery, Erasmus University Medical Center - Daniel den Hoed Cancer Center, the Netherlands.
S
S
Keereweer
A
A
Sewnaik
J
J
Kerrebijn
C A
CA
Meeuwis
H W
HW
Tilanus
J H W
JH
de Wilt
D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007583:Jejunum; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy; D019651:Plastic Surgery Procedures; D012086:Reoperation; D016879:Salvage Therapy; D013524:Surgical Flaps; D017211:Treatment Failure