title: Non-occlusive mesenteric ischaemia of a free jejunal flap.
abstract: Free jejunal transfer using microsurgery after oesophageal or pharyngeal cancer resection is a useful operative approach. However, the disadvantage of free tissue transfer is the risk of necrosis of the transferred tissue due to impaired blood supply. In addition, jejunal flaps are more prone to blood-flow disorders such as ischaemia and congestion compared with other types of flaps. The causes of local blood supply disorders after microsurgery are divided broadly into two classes: one is thrombosis of an artery and/or vein in the anastomotic region and the other consists of local physical factors such as compressive pressure derived from haematoma formation and the effect of infection of the vascular pedicle. In this report, two rare cases of blood-flow disorder of the transferred free jejunum are described. In both cases, no signs of significant infection or occlusion of the vascular pedicles were present and late necrosis progressed gradually. The patients showed remarkable weight loss and a poor nutritional state due to inadequate preoperative nutritional intake. The necrosis was considered to be a result of non-occlusive mesenteric ischaemia of a free jejunal flap, and the factors contributing to free jejunal necrosis were reviewed.
authors: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama, Okayama 700-8558, Japan. satoshiprs18@gmail.com
authors: Satoshi
authors: S
authors: Onoda
authors: Yoshihiro
authors: Y
authors: Kimata
authors: Kiyoshi
authors: K
authors: Yamada
authors: Seijiro
authors: S
authors: Koshimune
authors: Tomoo
authors: T
authors: Onoda
authors: Yasuhiro
authors: Y
authors: Shirakawa
mesh_terms: D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology*