[Vascularisation of a free jejunal graft at the neck in an insufficient vascular situation].

Free jejunal grafts are the method of choice for one-stage reconstruction of the hypopharynx and the upper esophagus. Prerequisites for a successful free transplantation are a sufficient arterial vascularisation and a corresponding venous drainage. In a 59-year old patient, an esophagectomy was performed because of a proximal esophageal cancer. The passage was primarily reconstructed by a pedicled colon interposition. Necrosis of the cranial graft occurred. After resection of the necrotic bowel, a free jejunal graft was introduced thoraco-cervically. The nutrient vessels of the graft were anastomosed to the upper thyroid artery and the vena thyroid ima. In an operative revision one day postoperatively due to lacking re-capillarisation, the arterial inflow stopped. The superior thyroid artery was cut at its cranial origin at the external carotid artery and microsurgically implanted into the common carotid artery. Hereafter, a venous outflow was re-established. But the critical time of ischaemia was exceeded. In another operative revision, the cephalic vein was exposed at the cranial upper arm, distally cut and anastomosed to the re-implanted superior thyroid artery. After the harvest of a second autogenous jejunal graft, the arterio-venous shunt was cut and the segments were anastomosed to the mesenterial artery and vein. Transpositions of arteries and veins with temporary formation of an arterio-venous shunt may be prerequisites for a sufficient vascularisation and can enable a successful free microsurgical transplantation even in critical vascular situations.