Reconstruction of the pharynx and cervical esophagus using free jejunal transfer

Although FJT has been perceived as unreliable, current FJT survival rates of 94% or greater, FJT salvage rates of up to 100%, and perioperative mortality of 6% or less demonstrate that FJT is a safe, reliable, one-stage method of reconstructing partial and circumferential pharyngoesophageal defects. FJT is associated with some morbidity; however, the procedure is well tolerated, and swallowing function is restored in 80% or more of patients within an average of 9 to 12 days after surgery. The success of the technique requires careful attention to details, such as designing the flap to avoid vein grafts, selecting large recipient vessels with high blood flow, careful in setting of the flap, meticulous microvascular anastomotic technique, close postoperative monitoring, and early, aggressive treatment of infection. If FJT failure should occur, a repeat FJT should be performed in the immediate postoperative period to increase the possibility of salvage and to decrease the risk of infection and mortality.