MESENTERIC FLAP IN FREE JEJUNAL TRANSFERS - A VERSATILE TECHNIQUE FORHEAD AND NECK RECONSTRUCTION

Background. The technique of free jejunal transfers has been widely us ed for pharyngoesophageal reconstruction. However, secondary infectiou s and fistulous complications may develop in extensive and preoperativ ely high-dose irradiated cases. Methods. A generous jejunomesenteric c omposite graft was harvested and the mesenterium was effectively appli ed for head and neck reconstruction. Results. The mesenteric flap conn ected with the revascularized jejunum was used as means for obliterati ng dead space in the head and neck region, as a cover for the cervical vessels, as a vascularized bolstering for the vascular and enteral an astomoses, or as a vascularized bed for skin grafting when the skin fl aps are deficient. Only one small fistula occurred in 10 patients who underwent the mesenteric flap. Conclusions. This versatile technique i s expected to reduce the incidence of postoperative complications in p haryngoesophageal reconstruction using free jejunal transfers. (C) 199 5 John Wiley and Sons, Inc.