Surgical complications and functional outcomes of 3191 jejunal free flaps used for reconstruction of circumferential defects following head and neck cancer resections: A systematic review

• Published in: Oral oncology 2025-01, Vol.160, p.107130, Article 107130
• Main Authors: Mortaja, Sarah, Chiumenti, Francesca Angela, Kalaskar, Deepak M., Dwivedi, Raghav C.
• Format: Article
• Language: English
• Subjects: Circumferential defect reconstruction; Free Tissue Flaps; Head and neck cancer; Head and Neck Neoplasms - surgery; Humans; Hypopharyngeal cancer; Jejunal free flap; Jejunum - surgery; Jejunum - transplantation; Pharyngooesophageal defects; Plastic Surgery Procedures - adverse effects; Plastic Surgery Procedures - methods; Postoperative Complications - epidemiology; Treatment Outcome
• ISSN: 1368-8375; 1879-0593; 1879-0593
• DOI: 10.1016/j.oraloncology.2024.107130

•Circumferential defects resulting from surgery of head and neck cancers are a reconstructive challenge for surgeons.•The jejunal free flap requires a single surgical session for harvesting and reconstruction, with a quick return of swallow.•Jejunal free flap has superior outcomes for fistula and stricture rates when compared to other forms of flap reconstruction.•Jejunal free flap has high rates of return to normal diet and speech production, however the latter has its limitations. Pedicled, fasciocutaneous and visceral flaps are all widely adopted for reconstruction after ablative surgery for advanced laryngeal, hypopharyngeal and cervical oesophageal cancers. With multiple options available, the choice depends on type and extent of the defect, patient’s general conditions and institution expertise or preference. Since its first description in 1959, the use of jejunal free flap (JFF) has been refined thanks to the introduction of microvascular anastomoses, progressively allowing to achieve low mortality and morbidity rates. Both swallowing and speech outcomes are also positively reported across studies. A systematic review of English literature on JFF in H&N cancer reconstruction published after 2000 was carried out on Medline and Embase. Thirty-six studies were included in the analysis with a total of 3191 JFF reconstructions. Primary outcomes were surgical complications and functional outcomes (quality of speech and oral alimentation). A cumulative review was created pooling complication rates reported in single studies, and overall rates were obtained for fistulas (11.39%), strictures (14.17%), total and partial flap failure (4.79 and 6.15% respectively) and perioperative mortality (3.1%). Functional outcomes were variably reported, with different qualitative and quantitative assessment methods showing overall positive results. When reported, we’ve included impact of adjuvant radiotherapy and the ability of JFF to tolerate it has been widely confirmed. Above results have also been compared with same outcomes registered for different flaps. Overall, studies over the past 20 years demonstrate good clinical and functional outcomes, proving JFF to be a reliable and safe method for reconstructing circumferential pharyngoesophageal defects.