Modified Externalized Mesentery Monitoring in Free Jejunal Transfer: Secondary Intention Healing and Midterm Scar...

Free jejunal transfer is a standard reconstructive procedure after pharyngolaryngoesophagectomy, and postoperative monitoring is essential to detect vascular compromise. The externalized mesentery technique described by Arata et al is used, but typically requires ligation or resection after monitoring and provides limited information on wound healing and scar outcomes. This study evaluated 3 aspects of modified externalized mesentery monitoring. First, we evaluated the limitations of venous assessment and found that mesenteric color change can serve as a reliable adjunctive indicator. In our series of 18 patients, arterial Doppler signals were detectable in all cases, whereas venous signals were not detectable in 6; mesenteric color changes facilitated early detection of venous congestion and timely intervention. Second, we found that ligation or resection of the externalized mesentery was not required. Fifteen of 18 patients were managed conservatively, allowing secondary intention healing without infection or bleeding. Daily care was straightforward, and avoiding ligation reduced procedural burden and bleeding risk. Third, we evaluated midterm outcomes of mesenteric healing and scar formation. Among 9 patients with outpatient follow-up, complete epithelialization was observed by 6 months, and scar quality was favorable (mean Vancouver Scar Scale score: 1.11; range: 0 to 4), independent of mesenteric exposure width. Modified externalized mesentery monitoring enabled conservative secondary intention healing, facilitated detection of venous compromise when Doppler signals were not detectable, and was associated with favorable midterm scar outcomes, thereby simplifying postoperative management in free jejunal transfer.