Abstract
Single stage reconstruction of circumferential pharyngo-esophageal defects using the free jejunum flap produces excellent functional results with minimal morbidity and mortality. The most serious complication with this flap is vascular compromise, usually within the first 24 - 48 hours after surgery. Compromised flaps are frequently diagnosed late often making their salvage impossible, so close postoperative monitoring of tissue perfusion is critical. Rapid identification and salvage of the failing flap increases the chance of a successful outcome.
Highlights
Single stage reconstruction of circumferential pharyngooesophageal defects using the free jejunum flap is an established technique [1]
A 72 year old female treated for a post-cricoid squamous cell carcinoma by pharyngo-oesophagectomy and free jejunum flap transfer developed a late thrombosis of the drainage vein
Vascularisation from the recipient bed is said to be adequate to maintain viability [12]. Based on these observations early re-exploration of the pedicle approach to flap salvage is recommended, and in our case the pedicle was successfully re-explored on postoperative day five
Summary
Single stage reconstruction of circumferential pharyngooesophageal defects using the free jejunum flap is an established technique [1]. It commonly produces excellent functional results with minimal morbidity and mortality [2,3,4,5]. The most serious complication with this flap is vascular compromise, namely inadequate venous drainage (85%) or arterial supply (15%) [6]. Sufficient venous drainage is the most critical factor for a successful free jejunal transfer. A 72 year old female treated for a post-cricoid squamous cell carcinoma by pharyngo-oesophagectomy and free jejunum flap transfer developed a late (post-operative day 5) thrombosis of the drainage vein. The flap compromise was recognized early and rescued by immediate re-exploration and re-anastomosis
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