ORIGINAL ARTICLE Free Jejunal Graft for Reconstruction of Defects in the Hypopharynx and Cervical Esophagus Following the Cancer Resections Dean Zhao & Xingqiang Gao & Limei Guan & Wenling Su & Jing Gao & Cunshan Liu & Xianyang Luo & Xiaoyan Li Received: 20 February 2009 / Accepted: 12 March 2009 / Published online: 31 March 2009 # 2009 The Society for Surgery of the Alimentary Tract Abstract Objectives The reconstruction of esophagus defects after hypopharyngeal and cervical esophageal carcinoma resection is an ongoing problem. The objective of this article was to investigate the techniques of the free jejunal graft for the reconstruction of hypopharyngeal and cervical esophagus and discuss the outcome related to the procedures. Subjects and methods From July of 2005 to December 2007, seven patients with hypopharyngeal and cervical esophageal cancer underwent free jejunal graft reconstruction of the hypopharyngeal and cervical esophagus. Their clinical data were retrospectively analyzed. All patients received postoperative radiotherapy and were followed up for 7–24 months. Results Despite the multistep and time-consuming procedure, free jejunal graft survival was 100%. Operation-induced complications did not occur in six patients. One patient developed pharyngeal fistula. Conclusion The present experience supports the use of free jejunal grafts in reconstruction of the hypopharyngeal and cervical esophagus defects after exenteration of the central compartment of the neck. A high successful rate with low incidence of complications in reconstruction of the hypopharyngeal and cervical esophagus was obtained in this study. Keywords Hypopharyngeal . Esophageal cancer . Free jejunal graft . Reconstruction . Microvascular Introduction In the restoration of the continuity of the alimentary tract after esophagectomy, the stomach or the colon remain the organs of choice to use. 1 However, when a malignant process arises in the cervical esophagus or in the hypo- pharynx, the use of those organs carries some problems. Several techniques have been developed, such as the delto- pectoral flap 2 and the musculocutaneous flaps, 3 and some disadvantages over those methods have been described, including the long operation time, high rate of flap necrosis, and other complications. The free jejunal graft, the method described by Miller and Lee, 4 has widely been used for reconstruction of the pharynx and hypopharynx, especially for proximal lesions, whereas gastric pull-up is the technique of choice for reconstruction of the hypopharynx and cervical esophagus when the resection extends below the thoracic inlet. 5–7 The goal of the free jejunal graft is a single stage reconstruction with low morbidity and mortality, short hospital stay, and early restoration of swallowing. In this article, we present our experience with this tech- nique performed in seven patients and discuss the outcome related to the procedures. Patients and Methods From July of 2005 to December 2007, seven patients with the hypopharyngeal and cervical esophageal defects under- went the reconstruction by using a microvascular free jejunal grafts. Mean age of patients was 57.5 years (ranged J Gastrointest Surg (2009) 13:1368–1372 DOI 10.1007/s11605-009-0877-8 D. Zhao (*) : X. Gao : L. Guan : W. Su : J. Gao : C. Liu : X. Luo : X. Li Department of Otolaryngology-Head & Neck Surgery, Xiamen First Hospital Affiliated Fujian Medical College, 55 Zhenhai Road, Xiamen City, Fujian Province 361003, China e-mail: xingqiang7211@yahoo.com.cn