Department of Plastic and Reconstructive Surgery, The Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia.
J Plast Reconstr Aesthet Surg. 2013 Jan;66(1):9-15. doi: 10.1016/j.bjps.2012.08.033. Epub 2012 Sep 18.
The Jejunal Free Flap (JFF) was first described by Seidenberg in 1957 for the reconstruction of pharyngolryngectomy defects. Historically, its outcome profile has been better than alternative reconstructions. Recently, the use of tubed Fasciocutaneous Free Flaps (FCFF) has been increasing as series reporting outcomes superior or equivalent to JFF are published. Our experience with JFF has been more positive than recently published reports suggest. This study aims to provide an accurate and up-to-date assessment of outcomes in JFF reconstruction of pharyngolaryngectomy defects and to compare these results to those of contemporary alternative techniques.
368 Consecutive free jejunum reconstructions were performed for pharyngolaryngectomy defects between 1977 and 2010. All patients had been assessed by a multidisciplinary Head and Neck Clinic prior to surgery. A systematic review of recent literature pertaining to pharyngolaryngectomy reconstruction outcomes was undertaken for comparison with our dataset.
70.9% of tumours in this series were T-grade 3 or 4. Perioperative mortality was 3.8% and flap failure occurred in 2.98%. The incidence of anastomotic leak was 8.2% and stricture occurred in 10.9%. A full oral diet was maintained by 91.6% of patients by day 12 on average. 70.6% underwent primary tracheo-oesophageal puncture and of these 78.1% had effective speech.
Overall, our data compares favourably with other series. The strengths of the JFF reconstruction are the capacity to maintain an oral diet, low stricture and leak rates and the versatility to reconstruct long segment defects. We have observed variability in leak rates throughout the study period, which may be operator dependant. The gap between outcomes for FCFF and JFF reconstructions has narrowed but the latter remains our reconstruction of choice for pharyngolaryngectomy defects.
1957 年，Seidenberg 首次描述了空肠游离皮瓣（JFF），用于重建咽喉切除术缺损。历史上，其结果优于其他重建方法。最近，随着报告结果优于或等同于 JFF 的系列研究的发表，管状筋膜皮瓣游离皮瓣（FCFF）的应用越来越多。我们的 JFF 经验比最近发表的报告更积极。本研究旨在对 JFF 重建咽喉切除术缺损的结果进行准确和最新的评估，并将这些结果与当代替代技术的结果进行比较。
1977 年至 2010 年间，对 368 例连续的游离空肠重建用于咽喉切除术缺损。所有患者在手术前均由多学科头颈部诊所进行评估。对最近关于咽喉切除术重建结果的文献进行了系统回顾，以便与我们的数据集进行比较。
本系列中 70.9%的肿瘤为 T 级 3 或 4 级。围手术期死亡率为 3.8%，皮瓣失败发生率为 2.98%。吻合口漏的发生率为 8.2%，狭窄发生率为 10.9%。平均 12 天内 91.6%的患者维持全口服饮食。70.6%的患者行原发性气管食管穿刺，其中 78.1%的患者有有效的言语。
总的来说，我们的数据与其他系列相比表现良好。JFF 重建的优势在于能够维持口服饮食、低狭窄和漏率以及重建长段缺损的多功能性。我们在整个研究期间观察到漏率的变化，这可能与术者有关。FCFF 和 JFF 重建结果之间的差距已经缩小，但后者仍然是我们选择用于咽喉切除术缺损的重建方法。
