Jejunum Tissue Transfer Workup

  • Author: Tamer A Ghanem, MD, PhD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jun 25, 2010
 

Imaging Studies

Direct imaging of the jejunum with endoscopy, barium swallow follow-through, or computerized tomography scanning is seldom performed.[3] Vascular studies of the superior mesenteric vessels are also not routinely performed.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Tamer A Ghanem, MD, PhD  Senior Staff, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System

Tamer A Ghanem, MD, PhD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen M Weber, MD, PhD  Assistant Professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Oregon Health & Science University

Stephen M Weber, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Phi Beta Kappa, and Triological Society

Disclosure: Nothing to disclose.

Mark K Wax, MD  Professor and Program Director, Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University; Service Chief, Department of Surgery, Section of Otolaryngology, Veterans Affairs Medical Center

Mark K Wax, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Canadian Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Terance (Terry) Ted Tsue, MD  Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Association for Research in Otolaryngology, Johns Hopkins Medical and Surgical Association, Missouri State Medical Association, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Anthony JP, Singer MI, Mathes SJ. Pharyngoesophageal reconstruction using the tubed free radial forearm flap. Clin Plast Surg. Jan 1994;21(1):137-47. [Medline].

  2. Seidenberg MD, Rosenak SS, Hurwitt ES, Som ML. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg. Feb 1959;149(2):162-71. [Medline].

  3. Cordeiro PG, Shah K, Santamaria E, Gollub MJ, Singh B, Shah JP. Barium swallows after free jejunal transfer: should they be performed routinely?. Plast Reconstr Surg. Apr 1999;103(4):1167-75. [Medline].

  4. Chen HC, Tang YB. Microsurgical reconstruction of the esophagus. Semin Surg Oncol. Oct-Nov 2000;19(3):235-45. [Medline].

  5. Clark JR, Gilbert R, Irish J, Brown D, Neligan P, Gullane PJ. Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope. Feb 2006;116(2):173-81. [Medline].

  6. Coleman JJ 3rd, Tan KC, Searles JM. Jejunal free autograft: analysis of complications and their resolution. Plast Reconstr Surg. Oct 1989;84(4):589-95; discussion 596-8. [Medline].

  7. Haller JR. Concepts in pharyngoesophageal reconstruction. Otolaryngol Clin North Am. Aug 1997;30(4):655-61. [Medline].

  8. Huang JL, Duan ZQ, Li-Yang, Guo ZW, Sun Q, Li AF, et al. Esophageal reconstruction by jejunal transfer. Ann Plast Surg. Jun 1999;42(6):658-61. [Medline].

  9. Kimata Y, Uchiyama K, Sakuraba M, Ebihara S, Nakatsuka T, Harii K. Simple reconstruction of large pharyngeal defects with free jejunal transfer. Laryngoscope. Jul 2000;110(7):1230-3. [Medline].

  10. Lorentz RR, Alam DS. The increasing use of enteral flaps in reconstruction for the upper aerodigestive tract. Current Opinon in Otolaryngology Head and Neck Surgery. 2003;11:230-235.

  11. Reece GP, Bengtson BP, Schusterman MA. Reconstruction of the pharynx and cervical esophagus using free jejunal transfer. Clin Plast Surg. Jan 1994;21(1):125-36. [Medline].

  12. Shangold LM, Urken ML, Lawson W. Jejunal transplantation for pharyngoesophageal reconstruction. Otolaryngol Clin North Am. Dec 1991;24(6):1321-42. [Medline].

  13. Smith DF, Ott DJ, McGuirt WF, Albertson DA, Chen MY, Gelfand DW. Free jejunal grafts of the pharynx: surgical methods, complications, and radiographic evaluation. Dysphagia. Summer 1999;14(3):176-82. [Medline].

  14. Theile DR, Robinson DW, Theile DE, Coman WB. Free jejunal interposition reconstruction after pharyngolaryngectomy: 201 consecutive cases. Head Neck. Mar-Apr 1995;17(2):83-8. [Medline].

 
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Transillumination showing the network of arches on the mesenteric border of the jejunum.
The segment of jejunum to be harvested is outlined. A small segment harvested adjacent to the main loop is used for monitoring purposes.
Neck surgical wound showing a circumferential pharyngeal defect from the base of tongue to the cervical esophagus.
Jejunal free flap with pedicle and short monitoring segment.
GI end-to-end anastomotic device used to couple the distal end of the jejunal flap to the proximal cervical esophagus.
This photo shows the completion of the pedicle anastomoses and the jejunal free flap anastomosis to the cervical esophagus and base of tongue. Jejunal monitoring segment is placed outside the wound.
After wound closure, the monitoring segment can be seen in the lateral aspect. It is dressed with Xeroform dressing to prevent gastric secretions from bathing the wound. It is taken down in 5-7 days postoperatively, at bedside.
 
 
 
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