Hypopharynx reconstruction by a revascularized jejunum flap

The poor prognosis of the hypopharyngeal cancer compels the surgeon to choose a technique which allows wide surgical resection associated with a reconstruction procedure resulting in a prompt restoration of physiological functions, low morbidity and a short time hospitalization. Total circular pharangolaryngectomy has certainly had some impact on the prognosis. Over the years a variety of methods have been used for reconstructing the upper digestive tract, e.g. visceral transfer, myocutaneous pedicled flaps and revascularized fascio-cutaneous or visceral (colon or jejunum) flaps. The revascularized free flap of jejunum is a flap with anatomo-physiological features suitable for the reconstruction of the hypopharyngo-oesophageal tract. The advantages of this method are: a single surgical session, fast recovery of physiological alimentation, possibility of large defects reconstruction, possibility of being performed even in patients previously treated with radiotherapy, good capacity to resist possible complementary radiotherapy. The Authors present 11 patients (10 males and 1 female, aged from 47 to 65 years, mean 54,7 years) affected by advanced (T3 - T4) hypopharyngeal cancer with initial extension to the cervical oesophagus who were referred to us in 1996 and reconstructed by jejunum loop. There were no deaths in the perioperative period and 9/11 (84.6%) of the flaps survived. In general the life quality of the patients is good; they do not have problems with dysphagia. Although the prognosis of hypopharyngeal cancer remains poor, jejunum autograft has shown to be an excellent choice for the reconstruction of the cervical hypopharyngo-oesophagus.