Salvage Procedures after Total Necrosis of a Free Jejunal Graft

• Published in: O.R.L. Journal for oto-rhino-laryngology and its related specialties Vol. 77; no. 5; pp. 262 - 267
• Main Authors: Ni, Song, Zhu, Yiming, Wang, Jian, Li, Dezhi, Zhang, Bin, Xu, Zhengang, Liu, Shaoyan
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2015
• Subjects: Aged; Combined Modality Therapy - adverse effects; Esophageal Neoplasms - therapy; Esophagectomy - adverse effects; Female; Follow-Up Studies; Free Tissue Flaps - blood supply; Free Tissue Flaps - pathology; Graft Rejection; Humans; Jejunum - pathology; Jejunum - transplantation; Laryngectomy - adverse effects; Laryngoplasty - methods; Male; Medical procedures; Middle Aged; Necrosis - surgery; Original Paper; Pharyngectomy - adverse effects; Reoperation; Retrospective Studies; Salvage Therapy - methods; Skin & tissue grafts; Salvage procedures; Gastric pull-up; Fistula; Free jejunal graft; Necrosis
• ISSN: 0301-1569; 1423-0275
• DOI: 10.1159/000433548

Purpose of the Study: To determine the appropriate salvage method after total necrosis of a jejunal graft after reconstruction of total laryngopharyngoesophagectomy or a larynx-preserving operation, considering the complexity of medical service in China. Procedures: We reviewed 5 patients with a mean age of 61 years who developed total jejunal graft necrosis and underwent reconstruction of a free jejunal transfer in our hospital. The total number and choice of salvage procedures, the symptoms and the results of salvage for the 5 patients have been reviewed. Results: Four of the 5 patients survived. One of them underwent gastric pull-up reconstruction and recovered well. One patient died due to severe infection after the loss of the jejunal graft and secondary gastric pull-up reconstruction. A temporary external fistula was formed in 3 patients after the initial jejunal graft necrosis, 2 of which underwent fistula repair 6 and 5 months later, while one went on long-term gastric tube feeding. Conclusion: Our results suggest that a temporary external fistula formation is an optional secondary salvage procedure after total necrosis of an initial jejunal graft, considering the relatively low quality of medical service in China.