Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases

Authors

  • Alexander Dionyssopoulos MD, PhD,

    1. Division of Plastic and Reconstructive Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
    2. Department of Plastic Surgery, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • Andrei Odobescu MD,

    1. Division of Plastic and Reconstructive Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
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  • Yasmine Foroughi MD,

    1. Division of Plastic and Reconstructive Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
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  • Patrick Harris MD,

    1. Division of Plastic and Reconstructive Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
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  • Eleni Karagergou MD,

    1. Division of Plastic and Reconstructive Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
    2. Department of Plastic Surgery, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • Louis Guertin MD,

    1. Division of Ear, Nose and Throat Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
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  • Pasquale Ferraro MD,

    1. Division of Thoracic Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
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  • Alain M. Danino MD, PhD

    Corresponding author
    1. Division of Plastic and Reconstructive Surgery, Montreal University Health Centre, Montreal, Quebec, Canada
    • Service de Chirurgie Plastique, Hôpital Notre Dame, Centre Hospitalier de l'Université de Montréal, Université de Montréal, 1560 rue de Sherbrooke Est, Montréal, Québec H2L4M1, Canada
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

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.

Study Design:

Case series.

Methods:

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.

Results:

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.

Conclusions:

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.

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