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Salvage Procedures after Total Necrosis of a Free Jejunal Graft
Song Ni1, Yiming Zhu, Jian Wang
1Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Purpose Of The Study:
To determine the appropriate salvage method after total necrosis of a jejunal graft after reconstruction of total laryngopharyngoesophagectomy or a larynx-preserving operation, considering the complexity of medical service in China.
Procedures:
We reviewed 5 patients with a mean age of 61 years who developed total jejunal graft necrosis and underwent reconstruction of a free jejunal transfer in our hospital. The total number and choice of salvage procedures, the symptoms and the results of salvage for the 5 patients have been reviewed.
Results:
Four of the 5 patients survived. One of them underwent gastric pull-up reconstruction and recovered well. One patient died due to severe infection after the loss of the jejunal graft and secondary gastric pull-up reconstruction. A temporary external fistula was formed in 3 patients after the initial jejunal graft necrosis, 2 of which underwent fistula repair 6 and 5 months later, while one went on long-term gastric tube feeding.
Conclusion:
Our results suggest that a temporary external fistula formation is an optional secondary salvage procedure after total necrosis of an initial jejunal graft, considering the relatively low quality of medical service in China.
