Purpose: Free jejunal flap transfer has become the first choice for reconstruction of the pharynx and cervical esophagus. Its ischemic time should be as short as possible because it has a high metablic rate and contains intestinal bacterial flora, which predispose to quick development of suppuration in the presence of ischemia. Therefore strategies have been evolved for the reexploration of free jejunal flap.

Method: Two hundred and tweny-three cases of free jejunal flap transfer were reviewed from 1983 to 2002. Among them 16 cases had been re-explored. The time before revascularization, thrombosis of vessels(artery, vein, or both), the other findings of re-exploration, and the complications were analyzed.

Result:Seven out of 16 re-exploration cases have been successfully salvaged. However, two of them developed later stricture in the reconstructed esosphagus. Five of them had thrombosis of artgery and 11 had thrombosis of vein. The time before revascularizatikon was from 2.5 to 7 hours (mean 230 minutes). Among the 5 cases of arterial thrombosis, 4 were salvaged. Among the 11 cases of venous thrombosis 3 were salvaged, but 2 of the 3 subsequently developed stricture regardless of survival of the muscle component of the jejunal flap. Five of the 7 salvaged cases had leakage which required secondary repair.

Conclusions: Early detection of vascular compromise is mandatory for salvage of a free jejunal flap, especially for those of venous thrombosis. The intestine is more susceptible to venous congestion than to arterial occlusion because of hemorrhagic infarct.(This is different from other free flaps.) When congestion is found in the ward, release of tension by removing sutures should be performed immediately before sending the patient to the operation theater for reexploration. For prevention of any more congestion, the selection of large recipient vein and liberal use of skin graft or local flaps should be considered to avoid compression from tight closure of wound and subsequent vicious circle.