Summary
Backgrounds
The degree to which the jejunum can reach upward is a significant consideration in
cervical oesophagus reconstruction with vascularised free jejunum transfer using the
thoracoacrominal vessels as recipient vessels. The present study aims to elucidate
this issue.
Materials and methods
In 30 fresh cadavers, the thoracoacrominal vessels were dissected, and the jejunums
were harvested, carrying the second branches of the superior mesenteric arteries and
veins as their pedicles. After the mesenteric vessels were anastomosed to the thoracoacrominal
vessels, the jejunums were advanced to their maximum upward degree, and the positions
of the oral ends were evaluated referring to the hyoid bone. The evaluation was performed
under three conditions. In the first condition, the jejunums were simply advanced.
In the second condition, tension of the mesenteriums was reduced by incising their
serosa. In the third condition, mesenterial incision was also performed, and the anastomosed
pedicles were placed under the clavicles.
Results
The jejunums can reach superior to the hyoid bone by 2.1 ± 1.5 SD cm for males and
by 1.9 ± 1.5 SD for females. By incising the mesenteric serosa, these distances can
be extended by about 2 cm for males and 1 cm for females. Further extension of 2 cm
can be obtained for both sexes by placing the pedicle under the clavicle.
Conclusion
With patients whose neck regions lack vessels available for vascular anastomosis,
the thoracoacrominal vessels are used in free jejunum transfer for cervical oesophagus
reconstruction. The findings of the present study are useful in planning this type
of reconstruction.
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
- Free jejunal graft reconstruction after resection of neck cancers: our surgical technique.Surg Today. 2009; 39: 925-928
- Free jejunal graft for reconstruction of defects in the hypopharynx and cervical esophagus following the cancer resections.J Gastrointest Surg. 2009; 13: 1368-1372
- Surgical management of carcinoma of the cervical esophagus.J Surg Oncol. 2007; 96: 166-172
- Pharyngo-esophageal reconstruction by free jejunal graft and microvascular anastomosis in a 10-year-old girl.J Pediatr Surg. 2004; 39: e10-e12
- Recipient vessel analysis for microvascular reconstruction of the head and neck.Ann Plast Surg. 2004; 52: 148-155
- Vessel-depleted neck: techniques for achieving microvascular reconstruction.Head Neck. 2008; 30: 201-207
- Double vascular anastomosis for safer free jejunal transfer in unfavorable conditions.J Reconstr Microsurg. 2008; 24: 531-536
- The thoracoacromial artery as the recipient artery for safer free jejunal transfer in patients with irradiated, extensively scarred necks.Br J Oral Maxillofac Surg. 2009; 47: 73-74
- Arteriovenous loops in microsurgical free tissue transfer in reconstruction of central sternal defects.J Thorac Cardiovasc Surg. 2010; 140: 1283-1287
- Corlett loop for microvascular reconstruction in a neck depleted of vessels.Br J Oral Maxillofac Surg. 2007; 45: 493-495
- An innovative treatment concept for free flap reconstruction of complex central chest wall defects–the cephalic-thoraco-acromial (CTA) loop.Microsurgery. 2007; 27: 481-486
- Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck.Head Neck. 2006; 28: 797-801
- The lateral island trapezius myocutaneous flap for circumferential reconstruction of hypopharynx and cervical esophagus.Dig Surg. 2001; 18: 93-97
- Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience.Ann Plast Surg. 1992; 29: 408-412
- Pectoralis myocutaneous flap for replacement of cervical esophagus.Head Neck. 1989; 11: 450-456
- Pectoralis major myocutaneous flap reconstruction of the laryngopharynx and cervical esophagus.Laryngoscope. 1988; 98: 1227-1231
- Reconstructive Pharyngeal and/or cervical esophageal defects.Arch Otolaryngol. 1985; 111: 193-197
Article info
Publication history
Published online: September 26, 2011
Accepted:
August 21,
2011
Received:
July 1,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
