TY - JOUR
T1 - The best salvage operation method after total necrosis of a free jejunal graft? Transfer of a second free jejunal graft
AU - Onoda, Satoshi
AU - Kimata, Yoshihiro
AU - Yamada, Kiyoshi
AU - Sugiyama, Narushi
AU - Sakuraba, Minoru
AU - Hayashi, Ryuichi
PY - 2011/8/1
Y1 - 2011/8/1
N2 - Aim: Transfer of a free jejunal graft is the first choice for reconstruction after total laryngopharyngo-oesophagectomy (TPLE). After total necrosis of a jejunal graft, possible salvage procedures include temporary external fistula formation and transfer of a second free jejunal graft. The present study determines the most appropriate salvage method. Patients and methods: We have transferred over 600 vascularised free jejunal grafts during the past 22 years for reconstruction, immediately after TPLE, either at the National Cancer Center Hospital or at Okayama University Hospital. A second free jejunal graft was transferred to treat the first vascularised free jejunal graft that had undergone total necrosis in five of these patients. We reviewed the total number of operations, the interval between the operation and the start of oral feeding, the outcomes and the follow-up periods of the five patients. Results: Each of the second free jejunal grafts was positioned without complications. All patients resumed postoperative oral food intake after a mean interval of 20.4 days. Four of the five patients remain free of tumour recurrence and in good health. Conclusion: Our results suggest that the best salvage method after total necrosis of an initial free jejunal graft is to transfer a second jejunal graft. Therefore, the severity of contamination of the neck due to jejunal graft necrosis must be minimised at re-operation to transfer a second free jejunal graft using microvascular anastomosis.
AB - Aim: Transfer of a free jejunal graft is the first choice for reconstruction after total laryngopharyngo-oesophagectomy (TPLE). After total necrosis of a jejunal graft, possible salvage procedures include temporary external fistula formation and transfer of a second free jejunal graft. The present study determines the most appropriate salvage method. Patients and methods: We have transferred over 600 vascularised free jejunal grafts during the past 22 years for reconstruction, immediately after TPLE, either at the National Cancer Center Hospital or at Okayama University Hospital. A second free jejunal graft was transferred to treat the first vascularised free jejunal graft that had undergone total necrosis in five of these patients. We reviewed the total number of operations, the interval between the operation and the start of oral feeding, the outcomes and the follow-up periods of the five patients. Results: Each of the second free jejunal grafts was positioned without complications. All patients resumed postoperative oral food intake after a mean interval of 20.4 days. Four of the five patients remain free of tumour recurrence and in good health. Conclusion: Our results suggest that the best salvage method after total necrosis of an initial free jejunal graft is to transfer a second jejunal graft. Therefore, the severity of contamination of the neck due to jejunal graft necrosis must be minimised at re-operation to transfer a second free jejunal graft using microvascular anastomosis.
KW - Appropriate salvage operation
KW - Free jejunum transfer
KW - Secondary reconstruction
KW - Total necrosis
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U2 - 10.1016/j.bjps.2011.02.005
DO - 10.1016/j.bjps.2011.02.005
M3 - Article
C2 - 21377437
AN - SCOPUS:79960846720
VL - 64
SP - 1030
EP - 1034
JO - Journal of Plastic, Reconstructive and Aesthetic Surgery
JF - Journal of Plastic, Reconstructive and Aesthetic Surgery
SN - 1748-6815
IS - 8
ER -