title: Monitoring buried jejunum free flaps with a sentinel: a retrospective study of 20 cases.
abstract: OBJECTIVE
  The free jejunum transfer has become a widely used reconstruction option after total laryngopharyngectomy. The aim of this study was to evaluate the effectiveness of using an exteriorized jejunal segment for flap monitoring.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Twenty patients with tumors involving the pharynx, larynx, or cervical esophagus were subjected to total laryngopharyngectomy and neck dissection. The resulting esophageal defect was reconstructed with a free jejunal flap based on a major branch of the superior mesenteric artery and vein. After completion of anastomoses with the recipient vessels, the flap was divided into two segments of common vascular supply. The smaller segment was exteriorized in the cervical region for direct monitoring of serosal color, temperature, peristalsis, and bleeding during the postoperative period. This sentinel was resected once the viability of the flap was judged appropriate.
  
  
  RESULTS
  Of the 20 patients who had free jejunum transfers for pharyngoesophageal reconstruction, 14 had an uneventful postoperative course, and six needed re-exploration due to signs of arterial insufficiency in the sentinel segment. On re-exploration, four flaps were found to have arterial thrombosis and two had no abnormality at the anastomotic site. One of the flaps that developed thrombosis was subsequently lost.
  
  
  CONCLUSIONS
  Monitoring of buried free jejunal flap with a sentinel is an effective method of assessing flap viability after total laryngopharyngectomy and guides re-exploration in cases of anastomotic complications.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Montreal University Health Centre, Montreal, Quebec, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dionyssopoulos
authors.forename: Andrei
authors.initials: A
authors.lastname: Odobescu
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Foroughi
authors.forename: Patrick
authors.initials: P
authors.lastname: Harris
authors.forename: Eleni
authors.initials: E
authors.lastname: Karagergou
authors.forename: Louis
authors.initials: L
authors.lastname: Guertin
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
authors.forename: Alain M
authors.initials: AM
authors.lastname: Danino
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008642:Mesenteric Veins / Q000601:surgery; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010610:Pharyngeal Neoplasms / Q000601:surgery; D010611:Pharyngectomy; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome