Motility differences in free colon and free jejunum flaps for reconstruction of the cervical esophagus

BACKGROUND: Free colon and jejunal flaps have been described as reliable and safe conduits for pharyngoesophageal reconstruction. Compared with free colon flaps, free jejunum flaps have a smaller diameter and intrinsic peristaltic movement, both of which are considered possible causes of dysphagia. In this investigation, the authors evaluated motility differences in free jejunum and colon flaps using radionuclide esophageal scintigraphy. METHODS: Patients who received free jejunum flaps (n = 12) or free colon (n = 1) or ileocolon flaps (n = 13) for reconstruction after pharyngoesophagectomy for cancer were included. Radionuclide esophageal scintigraphy was performed using technetium-99m-labeled sulfur colloid. Transit rate was evaluated at 1 second (pharyngeal or initial clearance) and 10 seconds (esophageal or clearance throughout). Clinical progression of swallowing was recorded postoperatively. Statistical analysis was performed using the t test. RESULTS: Mean pharyngeal clearance was 61 ± 20 percent for free colon and ileocolon flaps and 70 ± 16 percent for free jejunum flaps. Mean esophageal clearance was 50 ± 27 percent for free colon and ileocolon flaps and 69 ± 17 percent for free jejunum flaps. Esophageal transit rate was significantly shorter in patients who underwent reconstruction with free jejunum flaps (p = 0.04). At 1 year, 10 of 12 free jejunum patients and eight of 14 patients were tolerating solid foods. CONCLUSIONS: Although neither flap showed normal swallowing characteristics, free jejunum flaps displayed greater esophageal clearance and should represent the first choice in hypopharyngeal reconstruction. Free colon and ileocolon flaps should be reserved for very proximal oropharyngeal defects and when simultaneous voice reconstruction is desired.