JEJUNAL FLAP

ARTCILES

1)EVANS
2)BUNKE

INDICATIONS

1)Cervical esophageal reconstruction
2)reconstruction of the hypopharnyx
3)LIe unLImesenLerIc border oI LIe Iree jejunuI gruIL cun be IncIsed Lo creuLe un IsIund IIup cupubIe oI
cIosIng noncIrcumIerenLIuI deIecLs oI LIe Ieud und neck.
4)treatment of choice after the failure of gastric pull-up, reverse gastric tube, or transposition
of the colon.

ANATOMY

1)CATIN
a.Small in testine
b.From ligament of treitz [duodenum] to ileocecal valve
c.Flap is usually 40 cm distal to the ligament of treitz
2)PEDICE
a.2
nd
through 4
th
jejunal branches off the superior mesenteric artery
b.Up to 25 cm of jejunum can be transferred on a single arcade of mesenteric
vessels

PEARLS

1)the flap is inset in a isoperistaltic direction
2)SEQUENCE
a.do micro first
b.poor ischemia tolerance
c.superior anastamosis of jejunum 1
st

i.more difficult of the two
3)mucosal anastamoses are done in 2 layers
4)perform swallowing study prior to feeding
a.usually at PD # 10
5)place an NG tube under direct vision
6)A size mismatch between the hypopharynx and the jejunal segment may require an
antimesenteric incision on the jejunal segment to create a fishmouth widening of the
proximal jejunum.
7)MNIT#ING
a.IIberopLIc endoscopy remuIns LIe besL meLIod Ior evuIuuLIon oI LIe
jejunuI segmenL

COMPLICATIONS

1)salivary fistula
2)pharyngostomas
3)esophagostoma
4)abdominal wound dehiscence
5)peritonitis
6)intestinal obstruction
7)small bowel fistulae
8)EA#
a.venous thrombosis of the vascular pedicle
b.Hematoma and seroma
c.carotid rupture and rupture of the internal jugular vein
d.Pharyngeal cutaneous fistulae
i.usually observed at the proximal anastomotic site
ii.result from a difference in the diameter of the two segments
iii.If they occur on the side ipsilateral to the microvascular pedicle, they
should be diverted to minimize damage to the vessels
iv.Most fistulae close spontaneously within 15 to 20 days and can be
managed conservatively
ATE
u.Dysphagia is a common delayed complication
I.caused by continued edema of the jejunal segment
II.or an altered functional ability to swallow
b.ate stenosis of the jejunal anastomosis
I.particularly in patients who have had radiation therapy
II.most frequently at the proximal anastomosis
III.may require dilatation of the proximal cervical anastomosis to limit
dysphasia
iv.In patients with intractable obstructive symptoms, recurrence of tumor
must be considered and local biopsies are required