| Background Because the hypopharynx is occult, it is difficult to find the malignant tumor early. It is so later to diagnose this diease that the extending range is extensive. The defect created by surgical extirpation is too large to close. One of the most formidable problems facing the reconstructive surgeon is the management of the patient with advanced carcinoma of hypopharynx. Reconstruction of the hypopharynx has undergone a complicated evolution. Bircher described an antethoracic skin tube for the treatment of lye stricture in cervical esophagus and hypopharynx in 1894. As early as 1895, Biondi suggested replacing esophagus with stomach brought into chest through the hiatus. It is reliable and requires only one enteric anastomosis. But its disadvantages included the morbidity of a combined abdominal, thoracic, and cervical operation, frequent gastric reflux, and a high operative mortality. In 1911, Kelling used the transverse colon and Vulliet used the left colon in a subcutaneous route in continuity with a tube of skin to perform esophageal replacement. Colon interposition is an alternative method when previous stomach surgery prevents gastric transposition. Because of high complication rate it is not suitable now. Bakamjian introduced the deltopectoral flap in head and neck reconstruction in 1965, which allowed immediate reconstruction regard to length-width ratios. Pectoralis musculocutaneous flap was developed after discovery of the vessel under skin supplying the flap in the 1970s. Pectoralis musculocutaneous flap supplanted the deltopectoral flap because of its reliability and one-stage procedure. However, when the skin of it was tubed for circumferential defects, the bulk could result in obstruction. Realizing that conventional skin grafts were not suitable for covering these large defects, surgeons began to seek more proper methods of reconstruction. In 1958, Seidenberg et al. undertook experimental studies in dogs to develop the technique of revascularzing jejunal segment in the neck. But the technique of vascular anastomosis was not mature, the rate of free jejunal necrosis was high. With the development of microvascular surgery, free jejunal transfer became the choice for reconstruction of the hypopharynx and cervical esophagus. Objecjtive To analyze the clinic effect of free jejunal transplant reconstruction defects after surgery of hypopharyngeal carcinoma Methods Retrospective review of the achieves of 15 cases (8 males, 7 females, ages ranging from 49 to 67) with hypopharyngeal cancer who underwent pharyngoesophageal reconstruction with free jejunal after tumor ablation from1985 to 1999. (1)Cases: According to the clinic stage of UICC in 1997, there are 5 of stageâ…¢and 10 of stage â…£. Of the 15 cases, 7 were originated from pyriform sinus, 6 from posterior pharyngeal wall, 2 from postcricoid. (2)Methods of surgery: Eight patients were performed total pharyngolaryngectomy. Six patients were treated total pharyngolaryngectomy and partial oesophagectomy. All patients were reconstructed with free jejunal and one patient was assisted with pectorals major myocutaneous flap; Cervical lymph nodes was treated by comprehensive neck dissection in 4 patients, modified neck dissection in 2 patients , double lateral neck dissection in 1 patient, supraomohyoid neck dissection in 1 patient. Results No patient die in the period of surgery. The rate of complication after surgery was 33.3%. The overall rate of regularswallowing was 80%. The overall 3 and 5 years survival rate of 15 patients were 36.1% and 27.1% respectively. Conclusions The reconstructive technique of free jeunal enable the patients to rehabilitete the function of swallowing early. Because of its high surgery security and low complication rate, the reconstructive technique should be mastered.
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