Transplant-related experience in pharyngo-oesophageal reconstruction: use of organ preservation techniques to improve ischaemic tolerance in free jejunal flaps

Published:August 08, 2016DOI:


      Reconstruction of pharyngo-oesophageal defects remains a surgical challenge. Free jejunal flaps, first described by Seidenberg in 1959, are used to reconstruct circumferential defects, but their main disadvantage is sensitivity to ischaemia. Others are secretions, an unpleasant smell, and problems at the donor site. To improve the tolerance of the jejunal segment to ischaemia and to give the surgeon more time, we cool it after harvest and flush it with organ preservation fluid. We describe the technique in a small case series of seven patients.


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        • Perez-Smith D.
        • Wagels M.
        • Theile D.R.
        Jejunal free flap reconstruction of the pharyngolaryngectomy defect: 368 consecutive cases.
        J Plast Reconstr Aesthet Surg. 2013; 66: 9-15
        • Seidenberg B.
        • Rosenak S.S.
        • Hurwitt E.S.
        • et al.
        Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment.
        Ann. Surg. 1959; 149: 162-171
        • Walkinshaw M.
        • Downey D.
        • Gottlieb J.R.
        • et al.
        Ischemic injury to enteric free flaps: an experimental study in the dog.
        Plast. Reconstr. Surg. 1988; 81: 939-945
        • Küntscher M.V.
        • Hartmann B.
        • Germann G.
        Remote ischemic preconditioning of flaps: a review.
        Microsurgery. 2005; 25: 346-352
        • Lee D.T.
        • Lee G.
        Cold ischemia in microvascular breast reconstruction.
        Microsurgery. 2010; 30: 361-367
        • Eichhor W.
        • Blake F.A.
        • Pohlenz P.
        • et al.
        Conditioning of myocutaneous flaps.
        J. Craniomaxillofac. Surg. 2009; 37: 196-200
        • Li Y.S.
        • Li J.S.
        • Li N.
        • et al.
        Evaluation of various solutions for small bowel graft preservation.
        World J. Gastroenterol. 1998; 4: 140-143