Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James's experience

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 60; no. 6; pp. 577 - 582
• Main Authors: Hanson, R.P, Chow, T.K, Feehan, E, Eadie, P.A, Timon, C.T, Keogh, S
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.01.2007; Elsevier
• Subjects: Aged; Biological and medical sciences; Carcinoma, Squamous Cell - physiopathology; Carcinoma, Squamous Cell - surgery; Deglutition - physiology; Esophagectomy - methods; Esophagus - surgery; Female; Free flap reconstruction; Head and neck cancer; Humans; Hypopharyngeal Neoplasms - physiopathology; Hypopharyngeal Neoplasms - surgery; Jejunal free flap; Jejunum; Laryngectomy - methods; Larynx - surgery; Male; Medical sciences; Middle Aged; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Pharyngectomy - methods; Pharynx - surgery; Plastic Surgery; Quality of Life; Quality of life scores; Reoperation; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Survival Analysis; Treatment Outcome; Tumors; Head and neck cancer; Jejunal free flap; Quality of life scores; Free flap reconstruction; Human; Surgical resection; Functional analysis; Anatomical reconstruction; Malignant tumor; Quality of life; Experience; Jejunum; Functional recovery; Treatment; Surgery; Free flap; ENT disease
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2006.11.012

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.