title: False-negative monitoring flap in free jejunal transfer.
abstract: We treated a case that exhibited dissociation between blood flow in the transferred jejunum and the monitoring flap. The monitoring flap showed a false-negative, indicating blood flow to be favorable despite blood congestion in the transferred jejunum. The patient was a 69-year-old man. After tumor resection, reconstruction was performed with free jejunal transfer. Vascular anastomosis was performed on the jejunal artery and transverse cervical artery and on the jejunal vein (V1) and external jugular vein. After esophagus anastomosis, blood congestion was noted in the transferred jejunum. An engorged arcade vein (V2) was observed in the mesenterium on the transferred jejunum side. Therefore, it was anastomosed to the external jugular vein bifurcation. The first postoperative day, thrombus had formed in the vein (V2). The transferred jejunum side vein (V2) was re-anastomosed to the external jugular vein, and improved blood flow was observed in the transferred jejunum. Monitoring transferred jejunum blood flow with monitoring flap exteriorization appears to be a simple and highly reliable method. However, because the monitoring flap cannot directly evaluate transferred jejunum blood flow, blood flow obstruction can occur between the transferred jejunum and the true situation may not be reflected.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nihon University School of Medicine, Tokyo, Japan. kashimura2106@gmail.com
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kashimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakazawa
authors.forename: Katsumi
authors.initials: K
authors.lastname: Shimoda
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Soejima
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D005188:False Negative Reactions; D058752:Free Tissue Flaps; D006801:Humans; D007583:Jejunum / Q000098:blood supply / Q000601:surgery* / Q000637:transplantation; D008297:Male; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013927:Thrombosis / Q000150:complications; D016896:Treatment Outcome