Summary
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Partial vs total esophagectomy for advanced carcinoma of the hypopharynx.Arch Otolaryngol Head Neck Surg. 1987; 113: 69-72
- Free jejunal graft for reconstruction of oral, oropharyngeal, and pharyngoesophageal defects.J Reconstr Microsurg. 1984; 1: 83-94
- Options for reconstruction of the pharyngoesophageal defect.Otolaryngol Clin North Am. 1994; 27: 1151-1158
- The jejunal free flap in oral cavity and pharyngeal reconstruction.Otolaryngol Clin North Am. 1994; 27: 1159-1170
- Combined pectoralis flap and gastric pull-up for pharyngeal reconstruction.Head Neck. 1997; 19: 134-136
- Analysis of recurrence, complications, and functional results with free jejunal flaps.Head Neck. 1994; 16: 149-154
- Reconstruction with free jejunal autograft after circumferential pharyngolaryngectomy: eighty-three cases.Ann Otol Rhinol Laryngol. 1998; 107: 581-587
- Free jejunum transfers for functional reconstruction after tumour resections in the oral cavity and the pharynx: changes of morphology and function.Microsurgery. 1996; 17: 535-544
- Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment.Ann Surg. 1959; 149: 162-171
- Replacement of the cervical esophagus and hypopharynx by a revascularized free jejunal autograft. Report of a case successfully treated.N Engl J Med. 1961; 264: 342-344
- Pectoralis major myocutaneous flap reconstruction of the laryngopharynx and cervical esophagus.Laryngoscope. 1988; 98: 1227-1231
- The free radical forearm flap: a reliable method for reconstruction of the laryngohypopharynx after in-continuity resection.Acta Otolaryngol. 1998; 118: 419-422
- Pharyngoesophageal reconstruction with the tubed radial forearm free flap.Eur Arch Otorhinolaryngol. 1998; 255: 24-26
- Free jejunal patch flaps in oral and oro-pharyngeal reconstruction.J Laryngol Otol. 1999; 113: 680-682
- Quality of life of disease-free survivors of advanced (stage III or IV) oropharyngeal cancer.Head Neck. 1997; 19: 466-473
- The addition of mood and anxiety domains to the University of Washington quality of life scale.Head Neck. 2002; 24: 521-529
- Long-term functional results after pharyngoesophageal reconstruction with the radial forearm free flap.Am J Surg. 1994; 168: 441-445
- The fabricated radial forearm flap in pharyngolaryngeal surgery: saliva leakage and its prevention.Br J Plast Surg. 1995; 48: 212-217
- Radial forearm free flap pharyngoesophageal reconstruction.Laryngoscope. 2001; 111: 807-810
- Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases.Plast Reconstr Surg. 2003; 111 ([discussion 661–3]): 652-660
- Fasciocutaneous free flaps for hypopharyngeal reconstruction.J Reconstr Microsurg. 2002; 18: 1-5
- Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience.Scand J Plast Reconstr Surg Hand Surg. 1998; 32: 307-310
- Pharyngoesophageal reconstruction using a fabricated forearm free flap.Plast Reconstr Surg. 1985; 75: 463-476
- Jejunal transplantation for pharyngoesophageal reconstruction.Otolaryngol Clin North Am. 1991; 24: 1321-1342
- Reconstruction of the pharynx and cervical esophagus using free jejunal transfer.Clin Plast Surg. 1994; 21: 125-136
- A retrospective study of 66 esophageal reconstructions using microvascular anastomoses: problems and our methods for atypical cases.Plast Reconstr Surg. 1994; 94 ([discussion 285–7]): 277-284
- Quality of life: a dynamic construct.Soc Sci Med. 1997; 45: 221-230
- The University of Washington head and neck cancer measure as a predictor of outcome following primary surgery for oral cancer.Head Neck. 1999; 21: 394-401
Article info
Publication history
Published online: January 27, 2007
Accepted:
November 14,
2006
Received:
February 8,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
