Postoperative radiation-associated changes in free jejunal autografts

Free jejunal autografts are a preferred method of pharyngoesophageal reconstruction. Ten adult mongrel dogs underwent free jejunal transplantations to the neck, five being controls and five receiving a 55-Gy equivalent dose of radiation after 3 weeks. Histologic changes 10 months after radiotherapy included simplified and blunted villi with normal architecture loss; fibrous replacement of the lymphatics and microvasculature in the intravillous space; goblet cell increase; significant increase in lamina propria thickness and muscularis mucosa fibrous plates; focal destruction and replacement of muscle layers with fibrosis; gross hypertrophy of the myenteric plexus with increased fibrous tissue about the hypertrophied neural tissue; and significant perivascular fibrosis. Controls demonstrated only minimal changes. These adverse delayed effects of irradiation on revascularized jejunal autografts should be considered in planning the method of pharyngoesophageal reconstruction as well as timing of adjuvant radiotherapy.