Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 27:
Autogenous Jejunal Transplantation
  FIG. 27-04. The esophageal remnant is held with clamps at the base of the neck.

FIG. 27-05. The jejunum is isolated approximately 40 cm below the ligament of Trietz, and the arcade vessels visualized by transillumination.

FIG. 27-06. Drawing of proposed segment.

FIG. 27-07. After isolation of the pedicle vessels, the mesentery is divided to provide an adequate jejunal segment for transplantation.

FIG. 27-08. Drawing of isolated segment.

FIG. 27-09. The bowel is isolated with clamps and the pedicle divided. The proximal mesenteric vessels must be carefully controlled and double-ligated to prevent retraction and bleeding. The bowel is subsequently closed in standard fashion with interrupted silk sutures.

FIG. 27-10. Drawing of the proposed transplant. If the superior thyroidal vein is too small, venous anastomosis may be performed end-to-side to the internal jugular vein.

FIG. 27-11. Jejunal segment in place.

FIG. 27-12. Vascular repairs on left neck.

FIG. 27-13. Postoperatively, the patient is begun on tube feeding at approximately 5 days.


FIG. 27-14. A contrast swallow revealed no leaks at 10 days, and the patient was discharged from the hospital on oral liquids.


A 60-year-old man underwent a laryngopharyngectomy and partial esophagectomy and had reconstruction with local flap coverage. Subsequently, he developed a chronic cervical fistula. Six months after his prior procedure, the patient underwent a free jejunal transfer to reconstruct the cervical esophagus. Microanastomoses were performed again between the jejunal artery and the superior thyroid artery using 9-0 nylon suture. The venous anastomosis was end-to-end to the external jugular vein. A deltopectoral flap was simultaneously performed to cover the transplanted bowel. A follow-up contrast swallow on the tenth postoperative day showed no evidence of fistulae and the patient was again given liquids and discharged from the hospital. The deltopectoral flap was revised on the twenty-first postoperative day with no evidence of breakdown or loss of the jejunal segment.

next page...

  2002 © This page, and all contents, are Copyright by The Buncke Clinic