Analysis of recurrence, complications, and functional results with free jejunal flaps

The medical records of 20 patients undergoing revascularized jejunal flap reconstruction of hypopharyngeal defects were retrospectively reviewed to analyze the incidence of distal marginal recurrence, complication rates, and success of early functional restoration. This report is one of few in the literature to address distal marginal recurrence in patients undergoing jejunal free flap reconstruction of hypopharyngeal defects. In 15 evaluable patients, two (13%) developed distal marginal recurrences. Both patients had tumor involving the hypopharynx at the junction of the cervical esophagus. The major complication rate was five of 20 patients (25%) and included three flap failures, one death, and one intra-abdominal hemorrhage. The minor complication rate was 35%. The median hospital stay was 15.5 days and the median time to successful swallowing was 14.5 days. The functional success rate for swallowing was 58%. Because of the aggressive nature of this disease, we feel partial esophagectomy with jejunal flap reconstruction is warranted to achieve early functional restoration in a select group of patients when a 2-cm distal margin can be obtained above the cervical esophagus with frozen-section control, and the distal esophagus is normal.