Double vascular anastomosis in the neck for reliable free jejunal transfer.
To reduce the possibility of necrosis in free jejunal transfer after total pharyngolaryngo-oesophagectomy, we made a second set of arterial and venous anastomoses in addition to the usual cervical arterial and venous anastomoses. To obtain two different arterial flows (carotid and subclavian systems), the recipient arteries were the superior thyroid and the transverse cervical. For venous flow, the internal and external jugular veins were used. All flaps survived. This procedure, which is limited to the already dissected neck with no procedures in other areas, is less invasive than others. Its advantages are that when one vessel has thrombosed the other vessel functions as a safety valve, and the greater pliability of the vascular pedicles makes it easier to reach the recipient vessels. Because this method is theoretically safe and results in less possibility of losing a flap when the anastomosis is unreliable, the double-pedicled transfer can be an option for safer free jejunal transfer.
Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan. prs-bin@koto.kpu-m.ac.jp
Toshiaki
T
Numajiri
Yoshihiro
Y
Sowa
Kenichi
K
Nishino
Hitoshi
H
Fujiwara
Hiroshi
H
Nakano
Taketoshi
T
Shimada
Shigeru
S
Nakai
Yasuo
Y
Hisa
D000293:Adolescent; D000368:Aged; D000714:Anastomosis, Surgical; D002339:Carotid Arteries / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000534:rehabilitation / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000534:rehabilitation / Q000601:surgery; D007583:Jejunum / Q000098:blood supply / Q000601:surgery / Q000637:transplantation; D007601:Jugular Veins / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D037981:Neck Dissection; D019651:Plastic Surgery Procedures / Q000379:methods; D013348:Subclavian Artery / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*