A “watch window” technique for monitoring buried free jejunum flaps during circumferential pharyngolaryngectomy reconstruction

Abstract

The free jejunum flap approach is the optimal option for circumferential pharyngolaryngectomy reconstruction. In this study, we designed a "watch window" for monitoring buried free jejunum flaps, thereby allowing us to assess graft viability. From 2007 to 2011, 14 patients with hypopharyngeal cancer underwent circumferential pharyngolaryngectomy that was reconstructed using a free jejunum flap at the Sun Yat-sen University Cancer Centre. During the closing of the neck incision, a "watch window" was designed for postoperative monitoring. Two patients experienced thrombosis of the pedicle. One was detected early and successfully rescued by removal of the thrombosis, the other one managed with a second free jejunum flap. The success rate of the buried flaps was 92.9%. No pharyngocutaneous fistulas or strictures occurred. All patients eventually resumed oral feeding and swallowing. The "watch window" technique for monitoring buried free jejunum flaps is simple, reliable and useful for finding vascular problems. Level of evidence Case series.

Postoperative monitoring of the free jejunal flap: use of colour duplex and systematic review of available techniques

“…4,[6][7][8][9][10][11] Two papers described the use of an implantable Doppler probe [12][13] and Figure 1 Oesophageal reconstruction using a jejunal free flap two papers reported the watch window technique. [14][15] Microdialysis, 16 microendoscopy 17 and reflectance photoplethysmography 18 were described by one paper each.…”

“…The search identified two case series reporting the use a watch window. [14][15] This technique involves creating an external window overlying the flap through which the flap can be observed. The window is constructed by creating an opening, suturing jejunal serosa up to this opening and covering it with a thin split thickness graft.…”

Intraoperative free jejunum flap monitoring with indocyanine green near-infrared angiography

“…Although the watch window technique and sentinel segment technique have been reported for monitoring, a buried free jejunum flap is difficult to monitor postoperatively [8,9]. Currently, the method to intraoperatively monitor the flap relies on the classical observation of peristalsis, the serosal color, and capillary refill.…”

Development of a reflectance photoplethysmographic sensor used for the assessment of perfusion of free jejunum flaps: A case report

“…The exteriorised section will be used for monitoring the flaps color, temperature, peristalsis and bleeding during the postoperative period. Similar methods of this monitoring technique with possible variation to its surgical procedure are "watch window" or sentinel [5][6]9].…”

“…The most serious complication of free flap is anastomotic thrombosis which occurs post-operatively, resulting in graft necrosis [5]. The mortality rate of jejunal flap when used for reconstruction of the esophageal defect is between 2.4% and 5% which usually occurs within the first 3 postoperative days [6]. In intestinal flaps the tolerance for low levels of oxygen in blood is 2 hours, after which the tissue becomes necrotic [4].…”