Reconstruction of large defects in the oropharynx with a revascularized intestinal graft: an experimental and clinical report

Our experimental investigation in six mongrel dogs with free revascularized jejunal loop for intraoral lining shows functional adaptation of the small bowel mucosa clinically and histologically. Although 1 year after transplantation 70 percent or more of the graft's surface remains small bowel mucosa, the flattening and widening of the villi produces an epithelial layer that satisfies the conditions of the oropharynx. In 30 clinical cases with a follow-up period of over 4 years our experimental experience is confirmed. After extensive ablative surgery in the oropharynx, primary reconstruction with free revascularized jejunal loop in combination with mandibular replacement has some significant advantages: There is no cicatricial induration of the graft. Mucus production occurs. Flexibility of the grafts and almost unlimited transplant supply lead to satisfying reconstruction even in difficult anatomic sites. Mesenteric fat tissue serves as good transplant material for extended soft-tissue loss. There is good wound healing, owing to abundant blood supply and prompt agglutination of the serosa. The long vascular pedicle provides revascularization apart from the resection area, which is important in irradiated cases. Decreased mucus production after 2 hours of normothermic ischemia and the anatomic reconstruction of mandibular replacement make tracheostomy not necessary.