The free jejunal graft in head and neck reconstruction

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Over the past 2 years the free jejunal graft with microvascular anastomosis has been used in 12 consecutive cases. Careful follow-up included not only clinical assessment, but regular radiographic evaluation, as well as fiberoptic esophagoscopy and biopsy of the jejunum. In our experience the indications for this procedure can be classified as follows: 1. Total laryngopharyngectomy and partial esophagectomy for malignancy. 2. Radical pharyngeal resection for stomal recurrence after previous failed total laryngectomy (including mediastinal dissection). 3. Persistent benign pharyngeal stricture refractory to conservative management. 4. Second-stage pharyngeal reconstruction in patients with a pharyngostome and esophagostome. Aspects of the technique will be presented, as well as an analysis of the results. These results have proved most encouraging with only one absolute failure. Major advantages are a significant shortening of hospital stay and a much earlier and easier rehabilitation as compared to other methods of reconstruction. The only other significant complications in the series were stricture at the lower anastomosis and a temporary pharyngocutaneous fistula in one case. In conclusion, we at the University of Cincinnati Medical Center are of the opinion that free jejunal graft offers an excellent safe and relative easy method of pharyngeal and cervical esophageal reconstruction with significant advantages over other techniques.