Free Jejunal Flap Research Articles

Genitourinary Trauma

Sexual adjustment and long-term results following vaginal reconstruction with free vascular jejunal flap are not well known.The study aims to investigate sexual adjustment and long-term results among patients who underwent vaginal reconstruction with free vascular jejunal flap.A total of 34 women, aged 16–31 years (mean 23.5), who underwent vaginal reconstruction with a vascular jejunal flap between 2005 and 2011 were evaluated. Indications for reconstruction included the following: Mayer Rokitansky Kuster Hauser syndrome (29 patients), isolated vaginal agenesis (2 patients), androgen insensitivity syndrome (2 patients), and (1) history of gynecologic-oncologic surgery.The study evaluates the perioperative results, complications, satisfaction with sexual function, length and width of the neovagina.All of the surgeries were completed without any intraoperative complications. Three patients required reoperation because of postoperative venous compromise in the grafts. The flap success rate was 100%, and no infection was observed for any case. The mean follow-up was 50 months (between 20 and 87 months). The mean vaginal depth and diameter were satisfactory for all cases. Postoperatively, six patients complained of jejunal hypersecretion, one patient complained of mucosal prolapse, and one patient complained of vaginal constriction. The neovaginal prolapse was repaired via minor surgery. Twenty-seven were married and sexually active. Twenty patients completed the questionnaire on sexual function. Sexual function was assessed using the Female Sexual Function Index (FSFI). Eleven patients were satisfied with their sexual lives after surgery (FSFI scores ≥ 25).Based on our results, satisfactory sexual function was achieved using the free jejunal vascular flap. Erman Akar M, Özkan Ö, Özkan Ö, Colak T, and Gecici O. Sexual function and long-term results following vaginal reconstruction with free vascular jejunal flap. J Sex Med 2013;10:2849–2854.

Articulatory function in glossectomized patients with immediate reconstruction using a free jejunum flap

Postoperative articulation in 18 glossectomized patients was investigated. The subjects were: 5 cases of tongue tumour, 7 cases of tumour of the anterior part of the floor of the mouth and 6 cases of tumour of the lateral part. A new modification of the Freiburger test for speech audiometry was used as test material. Then the articulatory function was assessed according to an overall score based on 180 monosyllables, the manner of production of 171 initial consonants and the place of production of 85 glossal sounds. The cases of tumour of the tongue and the lateral part of the floor of the mouth had excellent scores in all classes of sounds, which were compatible with the normative data. The subjects of tumour of the anterior part of the floor of the mouth had low overall scores, low scores for plosive and affricative sounds, and very low scores for sounds produced with the rear of the tongue. The relation between the site or amount of resection and subsequent articulation was significantly poor in all categories of sounds for the cases of anterior tumour, particularly in the movement of the posterior portion of the tongue even though it was not involved in the operation. In all groups there was a weak negative relation between the amount of resection and postoperative articulation. In reviewing the literature, reconstruction with a free jejunum flap was considered to lead to better articulation than reconstruction by other techniques. The need to assess postoperative function objectively was stressed, to compare the postoperative functions and to determine the indications for the reconstructive technique.

Free flap reconstruction of recalcitrant hypopharyngeal stricture

A case report is presented of the use of a jejunal microvascular free flap for the reconstruction of a hypopharyngeal stricture caused by caustic ingestion. Although the airway was reestablished, there was aspiration and diplophonia. This case is discussed as an example of an effective treatment of a difficult problem, but one posing secondary problems arising from the use of jejunum.

Einzeitige Rekonstruktion des vorderen Halses mit der Kombinationslappentechnik

This technique is recommended for the one-stage reconstruction of the cervical esophagus, for the protection of the cervical vessels by soft tissues and for the substitute of the anterior neck skin. The microvascular free jejunal flap is transplanted and then covered by the myocutaneous pectoralis-major-island-flap. Indications are complete defects of the anterior neck after the resection of tumors, after the resection of necrotic tissues following radionecrosis, when all soft tissues in front of the prevertebral fascia have to be resected. Details of the surgical technique are explained. This combination flap technique proved to be useful in 4 patients without any complications.

Ten years experience with the free jejunal autograft

Retrospective analysis by chart review, personal interview, and physical examination identified 88 patients who received 96 jejunal free flaps over a 10 year period. Seventy-nine of these patients had cancer. There were 13 operative failures (13.5 percent) in 10 patients. Failures were attributed to arterial thrombosis in four instances, venous anastomotic problems in four instances, fistula and infection in the neck in one instance, carotid blowout in one instance, psychosis with avulsion in one instance, and an unknown cause in two instances. Seven second attempts at salvage of jejunal flaps were performed with five successes. There were five deaths in the perioperative period (6 percent). Of these, one was directly attributed to graft failure. The following eight abdominal complications required operation: wound dehiscence (four instances), small bowel obstruction (one instance), Mallory-Weiss tear (one instance), gastrostomy tube leak (one instance), and acute gastric dilatation (one instance). Complications in the neck included infection (six instances), infection requiring operation (three instances), hematoma (three instances), and suture line dehiscence (one instance). Fistulas developed in 28 patients (32 percent), 12 of whom required operative closure (43 percent). Significant stenosis developed in six patients, two of whom required operative revision. Of 79 patients treated for cancer, 34 died from progression of disease which recurred an average of 9.7 months postoperatively. Death ensued an average of 16.7 months postoperatively. Ten patients died with no evidence of disease. At last follow-up, 28 patients were alive without apparent disease. Twenty-six of these patients have good swallowing function. Significant palliation and a high rate of restoration of function are possible with the free jejunal autograft. Careful patient selection should markedly decrease operative morbidity and mortality.

微小血管吻合用スペーサーの臨床応用

The methods for reconstruction with a flap after resection of head and neck tumors have progressed since Bakamjian developed the D-P flap in 1965. During the intervening 21 years, such excellent flaps/organs as stalked muscle flaps, the free forearm flap, and the free jejunum flap have been devised.However, the fast progress of surgical techniques has brought with it a concomitant increase in the difficulty of training clinicians to apply said techniques.Therefore, we developed a spacer for use in performing microsurgical vascular anastomoses. We studied the difficulties involved in using it for patients undergoing oral reconstruction (with a forearm flap) in the treatment of oral cancer.Oral reconstruction by means of angiostomy featurs a free flap that includes anastomosis of the nourishing vessels with the transplanted vessels. This method obviously favors a more successful oral reconstruction than methods that use the conventional D-P flap or various muscle flaps.However, learning the operational technique presents a problem.This spacer is designed specifically for microsurgical vascular anastomoses. It was developed in 1983 at the Department of Head and Neck Surgery of the Cancer Institute Hospital, the 5leading author of this article.We introduced this spacer because it enhances the safety, simplicity, and reliability of microsurgical vascular anastomoses.

One-stage reconstruction of esophageal defect by free transfer of jejunum: treatment and complications.

We report on 20 patients with esophageal defects that were reconstructed by jejunum transplant with the help of microsurgical techniques. Sixteen attempts were successful, for a success rate of 80%. Three types of reconstruction were used: free jejunum transfer, free jejunum flap transfer, and partially pedicled jejunum transfer with the distal portion revascularized. This article emphasizes the complications of these procedures, including tearing of the jejunum mesentery, thrombosis at the anastomotic stoma, balloon-like distention of the cervical portion of the transferred jejunum, strangulation at the diaphragm foramen, and stenosis of the anastomotic stoma between the remnant of the esophagus and the transferred jejunum. Measures for prevention and treatment of these complications are also discussed.

Advanced Applications of Revascularized Free Jejunal Flaps for Difficult Wounds of the Head and Neck

Advanced Applications of Revascularized Free Jejunal Flaps for Difficult Wounds of the Head and Neck