title: Selective epithelial ischemia of transferred free jejunum after late loss of its vascular pedicle.
abstract: Free flaps are considered to revascularize from the surrounding tissue and survive without their original pedicle flow after a certain period postoperatively. We report 2 patients who developed mucosal ischemia of the transferred jejunum by ligation of its vascular pedicle 10 and 25 months after microvascular free jejunal transfer. Both patients had a history of heavy smoking, and had undergone definitive radiotherapy and previous surgery to the recipient bed. Both were treated conservatively; however, a stenotic change of the transferred jejunum remained in 1 patient. If poorly revascularized flaps, such as jejunal flaps, were transferred to the irradiated and scarred recipient bed, revascularization might never reach completion. If pedicle division is required in such cases, reanastomosis of the pedicle would be ideal regardless of the time after the transfer.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kadohide@qent.med.kyushu-u.ac.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Kadota
authors.forename: Junichi
authors.initials: J
authors.lastname: Fukushima
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kamizono
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Umeno
authors.forename: Torahiko
authors.initials: T
authors.lastname: Nakashima
authors.forename: Ryuji
authors.initials: R
authors.lastname: Yasumatsu
authors.forename: Shizuo
authors.initials: S
authors.lastname: Komune
mesh_terms: D000714:Anastomosis, Surgical; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000628:therapy; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D007583:Jejunum / Q000637:transplantation*; D008197:Lymph Node Excision; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D012907:Smoking / Q000009:adverse effects