RECONSTRUCTION OF A CIRCULAR DEFECT OF THE
HYPOPHARYNX AND CERVICAL PART OF ESOPHAGUS BY
A FREE JEJUNAL FLAP (Case Report)
Palenčár D.1, Hedera J.1, Fedeleš J.1, Doležal J.2, Pinďák D.3
1Department of Plastic Surgery, Medical School of Comenius University, Ružinov Hospital, Bratislava, 2Department of Otorhinolaryngology, Medical School of Comenius University, St. Cyril and Metod Hospital, Bratislava, 3Department of Surgery, Medical School of Comenius University, St. Cyril and Metod Hospital, Bratislava, Slovakia |
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Summary:
Patients with impaired continuity of the upper gastrointestinal tract are dependent on gastrostomy or jejunostomy
tube feeds, which significantly reduce their quality of life. Reconstruction of the hypopharynx and esophagus is
desirable in cases of congenital deformities, corrosive injuries, or defects after tumor resections. Free flap allows
for easier reconstruction of head and neck defects. In this article, the authors present a case of complete hypopharynx
closure in an oncology patient with a larynx carcinoma. The patient is a 60-year-old male diagnosed in 2002
with epidermoid carcinoma of larynx. The patient underwent laser resection of the tumor followed by radiotherapy
and chemotherapy. In 2003 the patient underwent pharyngo – laryngectomy for relapse of the larynx carcinoma.
Postoperatively the patient developed pharyngo – cutaneous fistula, which was reconstructed at the otorhinolaryngology
department by a muscle – cutaneous flap from the pectoralis major muscle. During the course of healing
the patient developed complete hypopharynx and cervical esophagus closure. Free flap of jejunum was recommended.
The surgery team used a 10 cm long section of jejunum; the recipient blood vessels were arteria transversa
colli and internal jugular vein. On the second day after the surgery patient developed salivary fistula in the
wound. The fistula healed spontaneously in five weeks. Pharyngoscopy revealed that the transplanted jejunum was
fully vital. Free flap of the jejunum allowed for upper gastrointestinal tract reconstruction and allowed the patient to
restart peroral intake.
Key words:
free jejunal flap, hypopharynx reconstruction, esophagus reconstruction
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