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
