The authors have no funding, financial relationships, or conflicts of interest to disclose.
Facial Plastics and Reconstructive Surgery
Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases†
Article first published online: 17 JAN 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 3, pages 519–522, March 2012
How to Cite
Dionyssopoulos, A., Odobescu, A., Foroughi, Y., Harris, P., Karagergou, E., Guertin, L., Ferraro, P. and Danino, A. M. (2012), Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases. The Laryngoscope, 122: 519–522. doi: 10.1002/lary.22382
- Issue published online: 21 FEB 2012
- Article first published online: 17 JAN 2012
- Manuscript Accepted: 14 JUN 2011
- Manuscript Revised: 4 JUN 2011
- Manuscript Received: 19 APR 2011
- Esophageal reconstruction;
- jejunum flap;
- sentinel flap;
- Level of Evidence: 4
The free jejunum transfer has become a widely used reconstruction option after total laryngopharyngectomy. The aim of this study was to evaluate the effectiveness of using an exteriorized jejunal segment for flap monitoring.
Twenty patients with tumors involving the pharynx, larynx, or cervical esophagus were subjected to total laryngopharyngectomy and neck dissection. The resulting esophageal defect was reconstructed with a free jejunal flap based on a major branch of the superior mesenteric artery and vein. After completion of anastomoses with the recipient vessels, the flap was divided into two segments of common vascular supply. The smaller segment was exteriorized in the cervical region for direct monitoring of serosal color, temperature, peristalsis, and bleeding during the postoperative period. This sentinel was resected once the viability of the flap was judged appropriate.
Of the 20 patients who had free jejunum transfers for pharyngoesophageal reconstruction, 14 had an uneventful postoperative course, and six needed re-exploration due to signs of arterial insufficiency in the sentinel segment. On re-exploration, four flaps were found to have arterial thrombosis and two had no abnormality at the anastomotic site. One of the flaps that developed thrombosis was subsequently lost.
Monitoring of buried free jejunal flap with a sentinel is an effective method of assessing flap viability after total laryngopharyngectomy and guides re-exploration in cases of anastomotic complications.