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The Free Jejunum Flap

Anatomic considerations

Tissue:
Small bowel with a root of mesentery, lymphatics and vascular inflow.
Innervation:
this flap is not innervated but it retains peristalsis and must be placed ante grade if tubed to prevent peristaltic reflux.
Blood supply:
Branches from the superior mesenteric artery and accompanying vein.
Artery:
A large caliber artery at least 3 millimeters in size depending on the level of harvest of jejunal branches.
Vein: The corresponding veins are large, comparable or larger in size than the artery.
Pedicle length:
Can be dissected up to 15 centimeters in length.

Vascular Anatomy

Dissection of the Posterior Flap

The vascular anatomy of the jejunum.

The small bowel is supplied by the superior mesenteric artery (SMA). The bowel is held by the mesentery, the base of which travels from the left upper quadrant at the ligament of Treitz to the right lower quadrant and the terminal ileum. The SMA distributes more than 10 major branches to the small bowel. The second or third branch provides adequate pedicle length and length of jejunum to supply the flap.

Operative Procedure

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