Artery-dominant free jejunal transfer

Summary 

Although the supercharge (additional microvascular anastomosis) technique is often used in pedicled transfer of parts of the gastrointestinal tract, this is rarely performed during free jejunal transfer (FJT). The differences in blood circulation and outcomes between the usual single pedicle flap and a double pedicle flap are not well known. Therefore, we evaluated the effect of an additional arterial anastomosis in FJT.

The FJT was performed using one venous and two arterial anastomoses after hypopharyngeal cancer ablation. To assess the effects of an arterial supercharge, blood–gas analysis, including the venous partial pressure of oxygen (pO₂) and partial pressure of carbon dioxide (pCO₂), was performed on samples drawn thrice from the jejunal vein: before harvest, after the anastomosis of a paired artery and vein and after an additional arterial anastomosis.

The result revealed that the venous pO₂ was elevated by the additional arterial anastomosis, compared with the two other measuring times (P=0.04). The venous pCO₂ did not show significant changes.

By being given a dominant artery, a jejunal flap can develop a physiological circulatory environment and can establish nutritional pathways without adverse effects.

Keywords: Anastomosis, Head and neck reconstruction, Hypopharyngeal cancer, Microsurgery, Supercharge