Microvascular reconstruction of the pharyngoesophagus with free jejunal graft

Free jejunal graft reconstruction of the pharyngoesophagus has become reliable one-stage technique, but the microsurgeon must be aware of numerous pitfalls. Forty-two patients were retrospectively reviewed. There were four graft failures for a success rate of 90.5%. When harvesting the graft the thick fatty mesentery may make dissection difficult, and injuries to the mesenteric artery and vein can occur. Neck preparation can be tedious because of previous radiation, and size discrepancies with the carotid branches and the mesenteric artery are seen. Intimal dissection of the mesenteric artery can present as an isolated flap or a circumferential "rosette," despite the most careful preparation of the vessels; and great care must be taken in the microvascular anastomosis. The end-to-end arterial anastomosis to a branch of the external carotid and an end-to-side venous anastomosis to the internal jugular were preferred. Vein grafts are occasionally necessary.