Extended sigmoid-shaped free jejunal patch for reconstruction of the oral base and pharynx after total glossectomy with laryngectomy

The procedure for reconstruction of the extensive defect after total glossectomy with total laryngectomy has not been standardised so far. We have devised a new method in which a free jejunal patch is extended to a sigmoid-shaped form specifically optimised for reconstruction of the defect that consists of the entire floor of the mouth and the antero-lateral walls of the pharyngoesophageal tract. After a jejunal segment of about 40 cm has been longitudinally opened in full length, the proximal quarter is folded parallel to the second quarter, which is then folded parallel to the third quarter in the opposite direction, to be laid out in a S-shaped form. Side-by-side sutures are then placed along each of the folded borders and corrective trimming is done to fit the defect. This widely extended patch replaces the whole oral base, whereas the remaining distal quarter of the patch replaces the antero-lateral walls of the hypopharynx and cervical esophagus. Because of the encouraging functional results with satisfactory restoration of oral alimentation, this procedure is considered to be ideal for the reconstruction of the defect which follows total glossectomy with total laryngectomy.