Modified Seromuscular Patch Flap for Reinforcing an Anastomosis Site in Hypopharyngeal Reconstruction Using Free Jejunal Transfer An Anatomical and Clinical Study

Abstract

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 f laps 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 f lap, a lead oxideYgelatin mixture was injected into the arterial system of 4 fresh cadavers. Results: The f lap 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 f lap. Conclusion: In conclusion, an incision along 1 side of the mesenteric border produces increased mobility of the jejunal seromuscular patch f lap. Angiography can demonstrate clear evidence of a reliable circulation. Key Words: jejunal seromuscular patch f lap, free jejunal transfer, total pharyngolaryngectomy, anastomotic fistula