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J Reconstr Microsurg 2008; 24(7): 531-536
DOI: 10.1055/s-0028-1088237
© Thieme Medical Publishers

Double Vascular Anastomosis for Safer Free Jejunal Transfer in Unfavorable Conditions

Toshiaki Numajiri1 , Takashi Fujiwara1 , Kenichi Nishino1 , Yoshihiro Sowa1 , Maki Uenaka1 , Shidu Masuda1 , Hitoshi Fujiwara1 , Shigeru Nakai2 , Yasuo Hisa2
  • 1Department of Plastic and Reconstructive Surgery, Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • 2Department of Otorhinolaryngology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Publication History

Publication Date:
16 September 2008 (online)

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ABSTRACT

Free jejunum was transferred to a patient with recurrent hypopharyngeal carcinoma under unfavorable cervical conditions, caused by prior therapeutic chemoradiotherapy for hypopharyngeal carcinoma and gastric pull-up with cervical leak, resulting from treatment for thoracic esophageal cancer. The cervical recipient vessels were buried in extensively scarred fibrous tissues, so they were thought to be less reliable. Because postoperative vascular occlusion was anticipated, in addition to the ordinary single vascular anastomosis to the damaged cervical vessels, secondary vascular anastomosis to the healthy chest vessels was performed. We designed the graft to have double vascular pedicles that communicated with each other through arcade vessels. This made it possible to anastomose doubly to an intact thoracoacromial artery in the chest by elongating the vascular pedicles of the mesentery without the need for an interpositional vein graft, in addition to ordinary anastomosis in the damaged neck. The flap is nourished by the vessels from two different origins (carotid and axillary arteries, internal jugular and axillary veins) at two different places (damaged and healthy areas). This method increases the quantity of feeding vessels while improving the quality of the recipient vessels within the local area and flow sources. It is one treatment option when conditions are unfavorable for safer jejunal transfer.

KEYWORDS

Thoracoacromial artery - cephalic vein - radiation - microsurgery - head and neck reconstruction

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Toshiaki NumajiriM.D. Ph.D. 

Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine

Kawaramachi-Hirokoji, Kyoto 602-8566, Japan

Email: prs-bin@koto.kpu-m.ac.jp

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