Jejunal Graft Reconstruction of Pharyngoesophageal Defects without Microvascular Anastomoses

Abstract

The purpose of this article is to describe transplantation of jejunal grafts without microvascular anastomoses for reconstruction of the pharynx and/or upper esophagus following oncologic resections. Even though use of free flaps including jejunum, a method that requires revascularization, continues to offer superior results in pharyngoesophageal reconstruction, the technique described in this article provides a readily available alternative. This timesaving technique is particularly useful if the surgeon encounters intraoperative complications related to either the microvascular anastomoses or to an unstable patient. The principal advantages of jejunal graft reconstruction include the absence of a need for microvascular anastomoses, a decreased operating time, a one-stage operation, and the replacement of pharyngoesophageal mucosa with like tissue. The disadvantages include the need for laparotomy, the requirement for a well-vascularized tissue bed, delayed wound healing, the need for stenting, and delayed initiation of oral intake.