Vascular pedicle division during free flap re-inset in pharyngoesophageal reconstruction

Background: Free intestinal flaps for pharyngolaryngoesophagus reconstruction may require revision operations, including free flap re-inset for functional improvement. This report aimed to present our experience on vascular pedicle division at the secondary procedure of free flap re-inset for functional improvement in pharyngoesophageal reconstruction. Patients and Methods: Eight male and seven female patients, with a mean age of 52 years old (range: 28–78 years), underwent pharyngoesophageal stricture (n = 7) and hypopharynx carcinoma reconstruction (n = 8) with three free jejunal and 12 free ileocolonic flaps. During revision procedure to shorten the flap for functional improvement, which was performed at 3 months after the initial operation, there were 11 venous and 4 arterial pedicle division cases. The intestinal flap circulation signs, such as presence of normoperistalsis, pink color, moderate secretion, and bleeding at puncture site, were observed for 1 hr. Results: No venous pedicle divisions required reanastomosis. However, all arterial pedicle division cases required immediate restoration with a vein graft because of immediate intestinal changes. No postoperative complications were seen, excluding a patient with anterior wall reconstruction who had arterial division and reanastomosis. Patients were followed up for a median duration of 28 months. Conclusion: For revision operations involving free intestinal flaps, the arterial pedicle must be protected or repaired if transected, whereas the venous pedicle does not necessitate such a maneuver.