title: Jejunal free flap for reconstruction of pharyngeal defects in patients with head and neck cancer-the Birmingham experience.
abstract: We retrospectively audited operative complications, success of flaps, and speech and swallowing outcomes in patients with head and neck cancer who had reconstruction with jejunal free tissue transfer to the pharynx. A total of 104 patients had jejunal free flaps between 1987 and 2009 at University Hospital, Birmingham. Management was by a multidisciplinary team, and the same vascular surgeon did all the anastomoses. We investigated the relations between patients, operative factors, and postoperative complications, and noted the ischaemic time of the flaps and coexisting conditions of the patients. Outcomes measured included initial and final survival rates of flaps, donor and recipient site complications, and speech and swallowing outcomes on discharge and up to 2 years postoperatively. Of the 104 patients, 14 (13%) had initial flap complications but overall flap survival was 97%. A total of 11 (11%) patients developed a fistula at a mean of 15 days postoperatively and 11 (11%) had minor donor site complications. A total of 95 (91%) were able to resume oral diet on discharge. Of the 44 who were followed up on discharge, 32 (73%) were able to maintain oral intake at 2 years and 31 (70%) could use their voice in everyday situations. The jejunal free flap enables the tumour to be removed, and reconstruction and restoration of function to be done in a single operation using tissue that is versatile. The operation is associated with low morbidity at the donor and recipient sites, and results in good speech and swallowing outcomes. The flap can also be used to reconstruct pharyngolaryngeal defects.
authors: University Hospital Birmingham, Core Surgical Trainee (OMFS), United Kingdom. Electronic address: racheljacqualine.walker@nhs.net.
authors: Rachel J
authors: RJ
authors: Walker
authors: University Hospital Birmingham, Consultant Oral & Maxillofacial Surgeon, United Kingdom.
authors: Satyesh
authors: S
authors: Parmar
authors: University Hospital Birmingham, Consultant Oral & Maxillofacial Surgeon, United Kingdom.
authors: Prav
authors: P
authors: Praveen
authors: University Hospital Birmingham, Consultant Oral & Maxillofacial Surgeon, United Kingdom.
authors: Tim
authors: T
authors: Martin
authors: University Hospital Birmingham, Consultant Otolaryngology, United Kingdom.
authors: Paul
authors: P
authors: Pracy
authors: University Hospital Birmingham, Consultant Otolaryngology, United Kingdom.
authors: Chris
authors: C
authors: Jennings
authors: University Hospital Birmingham, Consultant Vascular Surgeon, United Kingdom.
authors: Malcolm
authors: M
authors: Simms
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology; D003679:Deglutition / Q000502:physiology; D005260:Female; D005402:Fistula / Q000209:etiology; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000209:etiology; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology; D016896:Treatment Outcome; D014833:Voice Quality / Q000502:physiology; D052096:Warm Ischemia
keywords: Fistula; Flap survival; Head and neck cancer; Jejunal free tissue transfer; Postoperative complications; Speech and swallowing