Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases

Alexander Dionyssopoulos, Andrei Odobescu, Yasmine Foroughi, Patrick Harris, Eleni Karagergou, Louis Guertin, Pasquale Ferraro, Alain M. Danino

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objectives/Hypothesis: The free jejunum transfer has become a widely used reconstruction option after total laryngopharyngectomy. The aim of this study was to evaluate the effectiveness of using an exteriorized jejunal segment for flap monitoring. Study Design: Case series. Methods: Twenty patients with tumors involving the pharynx, larynx, or cervical esophagus were subjected to total laryngopharyngectomy and neck dissection. The resulting esophageal defect was reconstructed with a free jejunal flap based on a major branch of the superior mesenteric artery and vein. After completion of anastomoses with the recipient vessels, the flap was divided into two segments of common vascular supply. The smaller segment was exteriorized in the cervical region for direct monitoring of serosal color, temperature, peristalsis, and bleeding during the postoperative period. This sentinel was resected once the viability of the flap was judged appropriate. Results: Of the 20 patients who had free jejunum transfers for pharyngoesophageal reconstruction, 14 had an uneventful postoperative course, and six needed re-exploration due to signs of arterial insufficiency in the sentinel segment. On re-exploration, four flaps were found to have arterial thrombosis and two had no abnormality at the anastomotic site. One of the flaps that developed thrombosis was subsequently lost. Conclusions: Monitoring of buried free jejunal flap with a sentinel is an effective method of assessing flap viability after total laryngopharyngectomy and guides re-exploration in cases of anastomotic complications.

Original languageEnglish (US)
Pages (from-to)519-522
Number of pages4
Issue number3
StatePublished - Mar 2012
Externally publishedYes


  • Esophageal reconstruction
  • jejunum flap
  • Level of Evidence: 4
  • sentinel flap

ASJC Scopus subject areas

  • Otorhinolaryngology


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