Modified Seromuscular Patch Flap for Reinforcing an Anastomosis Site in Hypopharyngeal Reconstruction Using Free Jejunal Transfer
An Anatomical and Clinical Study
- Alternative Author(s)
- Choi, Jae Hoon
- Publication Year
- 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
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
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