Surgical treatment of hypopharyngeal cancers with extension to the postcricoid region generally requires a circumferential pharyngolaryngoesphagectomy followed by reconstruction of the upper aerodigestive tract.
Many techniques have been described in order to achieve a safe and functional reconstruction. Interposition of the jejunal free flap (JFF) is a well-established technique and is the flap of choice in our unit.
This is a retrospective review of all patients who required a JFF following pharyngolaryngoesphagectomy over an 9-year period. We studied medical charts, histological reports, and speech and language therapy assessments. Eight of the nine surviving patients completed a quality of life questionnaire. Analysis was carried out on patient demographics, flap survival, patient survival and quality of life including swallow function and speech restoration.
A total of 23 patients had 24 jejunal free flaps. There were four perioperative deaths. Two flaps failed, and were salvaged with a second JFF in one case and a gastric pull-up in the second. Functioning swallow was established in 74% of patients with four patients complaining of dysphagia. Speech was restored using an electrolarynx or Blom Singer valve in 70% of patients. Most patients required radiotherapy as part of their adjuvant treatment.
In our hands the JFF for reconstruction following pharyngolaryngoesophageal resection allows restoration of function following major ablative surgery.
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Published online: January 27, 2007
Accepted: November 14, 2006
Received: February 8, 2006
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.