FUNCTIONAL AND CANCEROLOGICAL ASPECTS IN USING JEJUNUM GRAFTS IN HEADAND NECK-SURGERY

In this article, we report about the experiences at our ENT-University Clinic in Vienna in 76 patients with free transplanted microvasculary anastomosed autologous jejunum used for reconstruction following exte nsive resection of mainly stage IV carcinomas in the head and neck. Je junum was inserted as a siphon-like tube between the trachea and the h ypopharynx in 43 patients primarily for restoration of speech (in 10 c ases the pharynx was also reconstructed). In 33 patients, the upper di gestive tract was reconstructed as either patch or tube. They were the n evaluated according to functional results of speech and swallowing, aesthetics as well as 5-year survival rates. We achieved good results in 35 speech patients (81.4 %) and in 22 swallowing patients (66.6 %). The aesthetic function was influenced favourably because the volume o f the jejunal transplant fills up the defect in the neck after resecti on and creates a tolerable neck-shape. The 5-year survival of all avai lable 54 patients was 26 %, patients for speech restoration 31.7 % and patients for swallowing restoration 17.5 %. These results are to be c onsidered under the aspect that patients with swallowing restoration p rimarily had more severe disease. Complications such as like periopera tive mortality and total necrosis can be avoided by careful evaluation of the patients to be operated on. With the experiences gained from t his study, we now have exact indications for the use of jejunum graffs and thus can expect very high rates of success.