title: Modified seromuscular patch flap for reinforcing an anastomosis site in hypopharyngeal reconstruction using free jejunal transfer: an anatomical and clinical study.
abstract: BACKGROUND
  Free jejunal transfer is commonly used as a reliable reconstructive method after total pharyngolaryngectomy. An anastomotic fistula is the most common complication in the early postoperative period, occurring in 5% to 35% of cases. There have been several studies regarding surgical techniques for minimizing fistula formation. Specifically, the vascularized seromuscular patch flap has been used for reinforcing the anastomosis site; however, this flap does not yield a sufficient range of motion because of traction on the vascular pedicle.
  
  
  METHODS
  Between 2004 and 2011, 4 patients underwent vascularized seromuscular patch flaps with free jejunal transfer. A short segment of jejunum on a mesenteric pedicle is usually opened longitudinally along the antimesenteric border to make a patch flap; however, we made a longitudinal incision along 1 side of the mesenteric border. To investigate the vascular anatomy of the flap, a lead oxide-gelatin mixture was injected into the arterial system of 4 fresh cadavers.
  
  
  RESULTS
  The flap had increased mobility without traction on the vascular pedicle and adequate circulation. In the injection study, it was shown that the modification guaranteed adequate circulation across the antimesenteric border and from the proximal to the distal end of the flap.
  
  
  CONCLUSIONS
  In conclusion, an incision along 1 side of the mesenteric border produces increased mobility of the jejunal seromuscular patch flap. Angiography can demonstrate clear evidence of a reliable circulation.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea; †Department of Plastic and Reconstructive Surgery, Institute of Ischemic and Hypoxic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea; ‡Department of Anatomy, School of Medicine, Keio University, Tokyo, Japan; and §Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors.forename: Jaehoon
authors.initials: J
authors.lastname: Choi
authors.forename: Hak
authors.initials: H
authors.lastname: Chang
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Minn
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Imanishi
authors.forename: Sadakazu
authors.initials: S
authors.lastname: Aiso
authors.forename: Hyoun Wook
authors.initials: HW
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007013:Hypopharynx / Q000601:surgery*; D007583:Jejunum / Q000098:blood supply / Q000637:transplantation*; D007825:Laryngectomy; D010611:Pharyngectomy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome