Free jejunal grafts for reconstruction of pharynx and cervical esophagus

Reconstruction of the pharynx and cervical esophagus continues to pose a challenge to the surgeon. Over the last 2 years the free jejunal graft with microvascular anastomosis has been used to reconstruct pharyngoesophageal defects in ten consecutive cases with failure in only one case, because of a malfunctioning microscope and a temporary pharyngocutaneous fistula. Eight procedures were performed for reconstruction of a pharyngoesophageal defect after an extensive excision of hypopharyngeal carcinoma, one for pharyngoesophageal defect due to cervical trauma in an accident, and another for corrosive atresia. In seven of these cases the unaffected larynx or normal part of the larynx was simultaneously preserved and reconstructed with laryngeal function restored totally in four cases and partially in three cases. The techniques of both pharyngoesophageal and laryngeal reconstruction are presented. In our experience this is a relatively safe and reliable single-staged procedure that provides easier and earlier rehabilitation compared to other methods of reconstruction. Furthermore, the majority of patients may have their larynges rehabilitated simultaneously.