Reconstruction of pharyngolaryngectomy defects using the jejunal free flap: a 10-year experience from a single reconstructive center.
BACKGROUND
Reconstruction following pharyngolaryngectomy presents a complex reconstructive challenge, and a single-stage, reliable reconstruction allowing prompt discharge from the hospital and return of swallowing and speech function is required. The authors present their 10-year experience of 43 jejunal free flaps for pharyngolaryngectomy reconstruction by a single team and outline their operative algorithm to minimize postoperative morbidity.


METHODS
The data for patients who underwent jejunal free flap reconstruction of circumferential pharyngoesophageal defects between March of 2000 and September of 2009 were reviewed retrospectively. All cases were included for analysis.


RESULTS
There were 31 male patients and 12 female patients, with 100 percent acute flap survival. The authors' overall benign pharyngocutaneous fistula rate was two of 43 (5 percent), with two of 29 (7 percent) occurring in the group without a prophylactic pectoralis muscle flap and zero of 14 occurring in the group that had a prophylactic pectoralis muscle flap. No fistulas occurred when the anastomosis was performed with the gastrointestinal stapler (zero of 48). The authors' overall benign stricture rate was six of 43 (14 percent). Thirty-six patients received either a primary or secondary tracheoesophageal puncture; of these, 28 of 36 (78 percent) used their tracheoesophageal puncture as their primary mode of communication.


CONCLUSIONS
The authors' recommendations for minimizing fistulas and stricture rate, following free jejunal reconstruction, include the gastrointestinal stapler for bowel anastomosis whenever possible, and the use of a prophylactic pedicled pectoralis major muscle flap for patients exposed to previous radiotherapy.
London, United Kingdom From the Departments of Plastic and Reconstructive Surgery, Ear, Nose and Throat Surgery, Radiology, and Speech and Language Therapy, Charing Cross Hospital, and the Kennedy Institute of Rheumatology, Imperial College.
Pouria
P
Moradi
Graeme E
GE
Glass
Duncan D
DD
Atherton
Simon
S
Eccles
Margaret
M
Coffey
Anooj
A
Majithia
Archibold J D
AJD
Speirs
Peter M
PM
Clarke
Simon H
SH
Wood
D000368:Aged; D000465:Algorithms; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000502:physiology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D010611:Pharyngectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013072:Speech, Esophageal; D017792:Surgical Stapling