|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
| Free jejunal graft makes possible an early surgical recovery by decreasing patient morbidity and reducing hospitalization.34 It avoids the thoracic mutilation produced by other reconstructive measures and most of the complications that usually occur after complex local and distant flap reconstruction. The use of other abdominal organs such as the stomach or colon has been associated with gastric esophageal reflux, delayed gastric emptying, mediastinitis, and empyema.35 Finally, there are no contraindications for preoperative radiation therapy and free jejunal transfer. Despite the difficulty of neck dissection, it is still possible to perform a simultaneous jejunal transplant concurrent with radiation. Otherwise, radiation therapy can begin approximately 3 weeks postoperatively.36,37
The donor area is relatively easy to dissect in patients who have had no previous abdominal surgery. In obese patients careful dissection is required to limit damage to the mesenteric vessels while dissecting through fat within the mesentery.23 The free jejunal graft method can be used when other methods have failed.31-40 It has conservatively diminished the frequency of complications, such as strictures and fistulae, seen in other methods that require anastomosis of skin line structures to the mucosa of the hypopharynx. The patient's quality of life is improved consistently through the reduction in hospitalization and the rapid return to oral nutrition with subsequent weight gain.39-40
The disadvantages of free jejunal transfer include the following:
1. A specialized microsurgical supporting team is needed to perform the microsurgical procedure.41
2. On occasion, the patient has difficulty with speech postoperatively when the transferred jejunal segment is redundant.
3. Laparotomy is required.
Despite these disadvantages, there is no formal contraindication for free jejunal transfer, although previous abdominal surgery and multiple previous neck procedures may cause increased difficulty in developing donor and recipient vessels.
|Ch. 27 Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14