Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 27:
Autogenous Jejunal Transplantation
  The free jejunal graft can be used to reconstruct both non-circumferential defects and circumferential defects to restore continuity of the upper GI tract.31 Once isolated as a free graft, the antimesenteric border of the free jejunal graft can be incised to create an island flap capable of closing noncircumferential defects of the head and neck. The addition of a transverse incision across the bowel can permit creation of a double island, which can be folded back on itself to obtain a double layer of closure and permit coverage of a larger surface area as well as mucosal lining and external coverage. The free jejunal graft can also be used as a complete intestinal conduit for reconstruction of circumferential defects and is particularly useful after the following five operative situations:

1. Glossolaryngectomy and partial esophagectomy 2. Laryngectomy and partial esophagectomy 3. Pharyngectomy for a second primary cancer following previous laryngeal surgery 4. Following pharyngectomy for benign stricture or after irradiation of the larynx 5. Following esophagectomy and pharyngectomy, particularly after the failure of local measures, skin grafting, and regional chest flaps.

Microsurgical transfer of a free jejunal graft may become the treatment of choice after the failure of gastric pull-up, reverse gastric tube, or transposition of the colon.

  Advantages and Disadvantages

The advantages of the free jejunal graft are as follows:

1. It is a single-stage procedure.

2. Surgery can be performed simultaneously by two teams with ablation of the laryngeal or pharyngeal tumor while the microsurgical team is harvesting the jejunal graft from the abdomen.

3. The free jejunal flap restores the most physiologic conduit for the upper GI tract by allowing mucosa-to-mucosa closure, secretory lubrication of the conduit, and limited interference with the normal anatomy of the digestive tract. 32

4. The free jejunal graft permits wide extirpation of the primary tumor with adequate margin and eliminates the problems of insufficient length of the substituted segment.

Up to 25 cm of jejunum can be transferred on a single arcade of mesenteric vessels. 33

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