Early Prediction of Anastomotic Leakage After Free Jejunal Flap Reconstruction of Circumferential Pharyngeal Defects

J Plast Reconstr Aesthet Surg. 2013 Mar;66(3):376-81. doi: 10.1016/j.bjps.2012.09.035. Epub 2012 Oct 25.

Abstract

Background: Anastomotic leakage from the free jejunal flap, if diagnosed late, can result in catastrophes. Our study aims to look for clinical parameters that allow early identification of leakage so that appropriate interventions can be taken.

Method: Between 1980 and 2011, consecutive patients with free jejunal flap reconstruction of circumferential pharyngeal defects were included. A retrospective chart review was then performed comparing the clinical parameters (body temperature, heart rate, serum albumin, haemoglobin and white cell count) between patients with no leakage and those with clinical and radiological leakage.

Level of evidence: 4.

Results: Ninety-six patients were included in the study. The median age was 62 years. Majority (69.8%) of the defects were created after resection of tumours in the hypopharynx. Five (5.2%) patients had clinical leakage and 12 (12.5%) had radiological leakage. There was no significant difference in body temperature, heart rate, incidence of atrial fibrillation and haemoglobin level between those with and without leakage. The serum white cell count was higher in the patients who leaked, but it became statistically significant only after day 7 postoperatively. The serum albumin level was significantly lower in patients with anastomotic leakage starting as early as day 3 after surgery, and the difference persisted until the leak was controlled. However, there was no significant difference in the plasma albumin level between those with clinical or radiological leak.

Conclusion: Both serum albumin level and white cell count identified the presence of anastomotic leakage from the free jejunal flap. Serum albumin allows early prediction of leakage so that early interventions can be taken to avoid the damage resulting from the delay in diagnosis.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Anastomotic Leak
  • Blood Chemical Analysis
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Free Tissue Flaps / adverse effects
  • Free Tissue Flaps / blood supply*
  • Humans
  • Hypopharyngeal Neoplasms / pathology
  • Hypopharyngeal Neoplasms / surgery*
  • Incidence
  • Jejunum / surgery
  • Jejunum / transplantation*
  • Male
  • Middle Aged
  • Pharyngectomy / methods
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology
  • Predictive Value of Tests
  • Preoperative Care / methods
  • Reconstructive Surgical Procedures / adverse effects*
  • Reconstructive Surgical Procedures / methods
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • Treatment Outcome