ELONGATION OF THE VASCULAR PEDICLE OF THE FREE JEJUNAL GRAFT

Abstract

The free jejunal graft is ideal for oral or pharyngeal reconstruction because of it is thin, versatile and self-lubricating. However, the vascular pedicle of the free jejunal graft Is occasionally too short. We described a new method for obtaining a long vascular pedicle of the free jajunal graft.
Usually the free jejunal graft is harvested with fan-shaped mesentery. Inside the mesentery, the jejunal arteries and veins form vascular arches, which then form the marginal branch along the jejunum. Eventually, small straight vessels (vasa recta) arise from the marginal artery and vein. The vascular pedicle of the free jejunal graft might be prolonged using these marginal vessels.
First, the vascular pedicle of the monitoring flap was elongated with marginal vessels in two cases, and the blood flow of the marginal vessels was confirmed. Then the long-pedicled free jejunal graft was successfully used for oropharyngeal reconstruction in a 51-year-old woman. In this case the vascular pedicle was elongated about 5cm.
Elongation of the vascular pedicle is beneficial for defects of the anterior oral floor, hypopharyngeal defect that extend to the cephalad side, and when no recipient vessel in the neck can be found after radical neck dissection. We believe that our method is useful for bridgeing the long distance between the jejunal vessels and the recipient vessels.