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Artery-dominant free jejunal transfer.

Toshiaki Numajiri1, Takashi Fujiwara, Kenichi Nishino

  • 1Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. prs-bin@koto.kpu-m.ac.jp

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
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Summary

Adding an extra arterial connection during free jejunal transfer (FJT) improves blood flow. This "arterial supercharge" technique enhances oxygen levels in the jejunal flap, promoting better circulation and healing after hypopharyngeal cancer surgery.

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Area of Science:

  • Reconstructive Surgery
  • Vascular Surgery
  • Oncology

Background:

  • Free jejunal transfer (FJT) is used in hypopharyngeal cancer reconstruction.
  • Supercharging (additional arterial anastomosis) is common in pedicled flaps but rare in FJT.
  • The circulatory impact of arterial supercharging in FJT is not well understood.

Purpose of the Study:

  • To evaluate the effect of an additional arterial anastomosis (arterial supercharge) in FJT.
  • To compare circulatory parameters between single and double arterial supply in FJT.
  • To assess the impact on jejunal flap viability and outcomes.

Main Methods:

  • FJT performed with one venous and two arterial anastomoses post-hypopharyngeal cancer ablation.
  • Blood-gas analysis of jejunal vein samples (pO(2), pCO(2)) at three time points: pre-harvest, post-single anastomosis, post-supercharge.
  • Comparison of venous oxygen and carbon dioxide levels to assess circulatory changes.

Main Results:

  • Venous partial pressure of oxygen (pO(2)) significantly increased after the additional arterial anastomosis (P=0.04).
  • Venous partial pressure of carbon dioxide (pCO(2)) showed no significant changes.
  • The arterial supercharge created a more physiological circulatory environment in the jejunal flap.

Conclusions:

  • An arterial supercharge enhances oxygenation in FJT.
  • This technique establishes nutritional pathways without adverse effects.
  • Arterial supercharging is a beneficial adjunct for FJT in hypopharyngeal reconstruction.