Usefulness of External Monitoring Flap in the Buried Jejunal Free Flap

유리 공장 피판술 후 외부 감시 피판의 유용성

  • Kim, Baek Kyu (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Chang, Hak (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Minn, Kyung Won (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Hong, Joon Pio (Department of Plastic Surgery, University of Ulsan, College of Medicine) ;
  • Koh, Kyung Suck (Department of Plastic Surgery, University of Ulsan, College of Medicine)
  • 김백규 (서울대학교 의과대학 성형외과학교실 성형재건연구소) ;
  • 장학 (서울대학교 의과대학 성형외과학교실 성형재건연구소) ;
  • 민경원 (서울대학교 의과대학 성형외과학교실 성형재건연구소) ;
  • 홍준표 (서울아산병원 울산대학교 의과대학 성형외과학교실) ;
  • 고경석 (서울아산병원 울산대학교 의과대학 성형외과학교실)
  • Received : 2007.02.01
  • Published : 2007.07.10

Abstract

Purpose: The jejunal free flap has the shorter ischemic time than other flap and requires a laparotomy to harvest it. As the evaluation of the perfusion the buried flap is very important, the perfusion of the buried jejunal free flap requires monitoring for its salvage. We tried to improve the monitoring flap method in the jejunal free flap and examined its usefulness. Methods: From March 2002 to March 2006, the monitoring flap method was applied to 4 cases in 8 jejunal free flaps for the pharyngeal and cervical esophageal reconstructions. The distal part of the jejunal flap was exposed without suture fixation through cervical wound for monitoring its perfusion. The status of perfusion was judged by the color change of jejunal mucosa and mesentery. If necessary, pin prick test was performed. Doppler sonography was applied to mesenteric pedicle of the monitoring flap in case of suspicious abnormal circulation. Results: The monitoring flap shows no change in 3 cases, but the congestion happened in one case at the 12 hours after the operation. This congestion was caused by the twisting or kinking of the mesenteric pedicle of the monitoring flap. So, we fixed up the monitoring flap close to adjacent cervical skin for prevention of rotation. Finally, the main part of transferred jejunal flap was intact. Conclusion: The success of a jejunal free flap depends on close postoperative monitoring and early detection of vascular compromise. So, various monitoring methods have been tried, for instance, direct visualization using a fiberoptic pharyngoscope, through a Silastic window placed in the neck flap, or external surface monitoring with an Doppler sonography, use of a buried monitoring probe. But, all of the above have their own shortcomings of simplicity, non-invasiveness, reliability and etc. In our experience, monitoring flap can be a accurate and reliable method.

Keywords

Acknowledgement

Supported by : 한국과학재단

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