• Journal of Chest Surgery
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• v.24 no.12
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• pp.1232-1237
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• 1991

The cervical esophageal stricture has various surgical modalities and difficulties in reconstruction. We had experienced a case of successful reconstruction of the cervical esophageal restenosis using the free jejunal graft, on 30 year old man had had esophageal stricture after ingestion of lye. He had undergone colon interposition[esophagocologastrostomy] with left colon feeding gastrostomy. But restenosis was occurred just above of the cervical esophagocolostomy site several times of balloon dilatation were failed. So, we decided to use of the free jejunal graft. The free jejunal graft was isolated about 15cm length with it`s vascular arcades. The graft was irrigated with the mixed solution as isotonic saline, heparin and papaverine chloride. The artery of graft was anastomosed to the branch of the external carotid artery in end to side with continuous sutures of the 8.0 Prolene. The vein of the graft was anastomosed to the branch of the anterior facial vein in end to end with continuous sutures of the 8.0 prolene. Postoperative course was uneventful and the patient was discharged after removal of the tracheostomy cannula and gastrostomy tube.

• Korean Journal of Bronchoesophagology
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• v.2 no.1
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• pp.63-70
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• 1996

Reconstruction for hypopharynx and cervical esophagus after wide resection of extensive hypopharynx and larynx cancers have been used various methods including myocutaneous flaps, gastric pull up, md jejunal or large bowel free graft. Recently, the authors had experienced hypopharynx and larynx cancers with extension to the posterior hypopharyngeal wall and thoracic esophagus. Of course, these reconstructive methods should be selected in accordance with the patient's age, physical status, extend of prim.:W lesion, and defect after on block resection, however, gastric pull up was performed in hypopharynx cancer which had skipped lesion in the thoracic esophagus and jejunal free grafts were performed in case 2, 3 which had a extended lesions to the posterior pharyngeal wall. Some complications were noted, which were successfully stabilized by conservative managements. The gastric pull up and jejunal free graft were considered suitable methods for reconstrunction of hypopharynx and cervical esophagus, however, further studies are necessary about it.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.515-521
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• 1991

Since Carrel in 1907 reported transfer of a free jejunal segment in dog, reconstruction of the cervical esophagus and hypopharynx has been accomplished successfully with free jejunal transplantation using microvascular technique. Free jejunal graft is useful in cases of failed colonic interpositions. Three patients with benign esophageal stricture had undergone reconstruction with right colon interposition. Because of necrosis and stricture of the interposed colon, in each case the defect was reconstructed with a free jejunal graft by using microvascular technique. The postoperative course in two patients was uncomplicated, and they were able to eat general diet. Graft necrosis occurred in one patient, but she is waiting for a reoperation.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.775-779
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• 1984

Reconstruction of the pharynx and cervical esophagus is a difficult surgical problem. A successful case of reconstruction of cervical esophagus by free jejunal graft upon a 23-year-old female who had stricture in the pharynx and cervical esophagus after ingestion of hydrochloric acid is presented. This procedure was done after the primary traditional reconstruction with right sided colon had resulted in restenosis due to necrosis of the cervical portion of the graft. A proximal jejunal segment, about 12 cm in length was isolated for free graft preserving its vascular arcade. Both superior thyroid artery and vein were anastomosed to the graft vessels in end to end by continuous suture of 8-0 monophil. Nylon. The postoperative course was uneventful. The patient has been followed for 4 months after operation and she can eat every kind of food without dysphagia. We think free jejunal graft offers an excellent and safe method of reconstructing cervical esophagus and pharynx with definitive advantages over other traditional techniques.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.47-53
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• 1998

Despite of technical advances in surgery & other therapeutic modalities five-year survival rates in patients with carcinoma of hypopharynx have remained low. Many techniques have been used to create a structure capable of allowing the passage of food and fluids in an attempt to maintain the anatomy and physiology of the upper digestive system. The development of microsurgical techniques and the concept of mucocutaneous unit has brought about important changes in the reconstruction of cervical esophagus following tumor resection. The one-stage procedure using microvascular anastomosis of free jejunal graft provides physiologic reconstruction of cervical esophagus and has a low morbidity rate as well as a short recuperation time. With free jejunal graft, there is marked improvement in the quality of life and numerous advantages over the previous methods of reconstruction. Reconstruction of esophageal defect after resection of carcinomas of the hypopharynx, and cervical esophagus has traditionally been carried out with deltopectoral, or musculocutaneous skin-lined flaps. A second approach is to reconstruct the defect with the colon or stomach. A more ideal mettled is to repair these defects with mucosa-lined flaps. The authors experienced 35 cases of reconstruction of cervical esophagus after resection of carcinoma of the hypopharynx with free jejunal autograft and one case of secondary repair with radial forearm free flap after failure of initial free Jejunal autograft. Postoperative results were satisfactory in most patients and two patients expired in 8 days postoperatively because of carotid blow out by chronic inflammation.

• Journal of Chest Surgery
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• v.38 no.6 s.251
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• pp.445-449
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• 2005

The management of failure of colonic graft or corrosive stricture with impaired colonic circulation continues to be a challenge to surgeons. We present four cases of complicated corrosive esophageal stricture, which were successfully treated using jejunal free graft. As the initial surgical treatment, three patients underwent colonic interposition, and one underwent Whipple's procedure due to panperitonitis. Ore patient underwent transposition of jejunal free patch graft, two underwent interposition of jejunal free graft, and one underwent esophagojejunocolojejunostomy using jejunal free graft. All patients did not show dysphagia after long term follow-up. Complex esophageal reconstruction with jejunal free graft was performed successfully and long term functional outcome was good.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.140-147
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• 1994

Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons. Over the past 2 years[1990, Dec.-1993, Jun], the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.The indications of this procedures were almost malignant neoplasms involving neck and upper aero-digestive tract; Hypopharyngeal cancer[12 cases, including 2 recurrent cases], laryngeal cancer[2 cases], thyroid cancer[2 cases, including 1 recurrent case], cervical esophageal cancer[1 case]. There were fifteen men and two women, and the mean age was 59.6 years. The anastomosis site of jejunal artery were common carotid artery[16 cases] or external carotid artery[1 case] and that of jejunal vein were internal jegular [15 cases] or facial[1 case] and superior thyroid vein[1 case]. The length of jejunal graft was from 9 cm to 17 cm[mean 13 cm] and the mean ischemic time was 68 minutes. There was one hospital mortality which was irrelevant to procedures[variceal bleeding] and one graft failure[1/16]. Other postoperative complications were neck bleeding or hematoma[3 cases], abdominal wound infection or disruption[5 cases], anastomosis site leakage[1 case], pneumonia[2 cases], graft vein thrombosis[1 case], and food aspiration[1 case]. The function of conduit was excellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases. During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcome with dilation. In conclusion, we think that the free jejunal graft is one of the excellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity rate.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1392-1397
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• 1996

Over the past two years the free jejunal transfer have been used in 7 consecutive patients to restore alimentary tract continuity artier the resection of esophagus. Six patients had squamous cell carcinomas and one had esophageal stricture . The patients underwent partial esophagectomy with modified radicAl neck dissection or mediastinal Iymph node dissection. The microvascular anastomosis was performed to the neck vessels in 4 patients and to the in ercostal vessels in 3 patients. Postoperative complications were graft necrosis in one patient, and a temporary anastomotic leakage with spontaneous closure in one patient. Reconstruction of the esophagus was successful in 6 of 7 patients. We emphasize that esophagectomy followed by transplantation of a free jejunal transfer is suitable for esophageal carcinoma or intractable esophageal stricture, and involvement of the midesophagus is not a contraindication to the use of the free Jejunal transfer.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.449-452
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• 1997

We managed surgically a case of local recurrence in esophageal cancer Twenty month after transthoracic subtotal esophagectomy and csophago-gastrostomy, he su(fared from dysphagia. Chest CT and percutaneous needle aspiration biopsy showed . Local recurrence involving residual esophagus, thyroid gland, posterior membraneous portion of trachea. We did cervical esophagectomy, laryngectomy thyroidectomy, partial resection of trachea and reconstruction with free jejunal antograft successfully.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.38-43
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• 2000

The reconstruction for the pharynx and cervical esophagus after wide resection in essential procedures and the several methods have the reported. Each method has advantages and disadvantages relatively. Five cases of free jejunal graft were analyzed retrospectively for the reconstruction of pharynx and cervical esophagus at Chungbuk National University Hospital from May 1996 through December 1998. Primary sites were one oropharyngeal cancer, three hypopharyngeal cancers and one subglottic cancer involved the cervical esophagus. Two grafts had necrosis. Postoperative minor complications were dysphagia, fistula, stricture of anastomosis site, and pneumonia in the order. There were not possible voice rehabilitation in three success cases.