TY - JOUR
T1 - Baseline motility of the free jejunal graft in a new canine model
AU - Scher, Natan
AU - Wiederhold, Michael L.
AU - Garza, Jaime R
AU - Pingree, Timothy F.
AU - Haughey, Bruce H.
N1 - Funding Information:
Received January 17, 1990, from the Department of Otolaryngology, The Un<versity of Texas Health Science Center, San Antonio, TX; and Audie L. Murnhv Memorial Veterans’ Administration Hospital. Accepted for publication March 20, 1990. *Present address: Department of Otolaryngology-Head & Neck Surgery, LSU Medical Center, 1542 Tulane Ave, New Orleans, LA 70112-1272. tPresent address: Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St Louis, MO 63108. Supported by the Research and Development Service of the Veterans’ Administration. Address correspondence and reprint requests to Natan Scher, MD, Department of Otolarvngolom, _ - Box 412. Univer- sity of Chicago; 5841 S Maryland Ave, Chicago, IL 60637. 0 1990 bv W.B. Saunders Comoanv. 0196-070kf90/1106-0008$5.00/6 -
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 1990
Y1 - 1990
N2 - Reconstruction of pharyngoesophageal defects using free jejunal grafts has become an accepted technique of reconstruction. However, there are functional problems associated with the jejunal graft. We developed a canine model that allows us easy access to perform various studies on grafted jejunum, including videofluoroscopy and pressure manometry to determine baseline function. Using a microvascular technique, free jejunal grafts 10 to 30 cm in length were implanted in 11 mongrel dogs. The jejunal segments were implanted subcutaneously and exteriorized proximally and distally. The grafted dogs underwent videofluoroscopic studies. These studies revealed three different types of jejunal graft contractions of variable intensity: circumferential, longitudinal, and mixed. These contractions resulted in four patterns of barium movement: anterograde propulsion, retrograde propulsion, to-and-fro motion, and peristaltic propulsion. Videofluoroscopic studies were repeated on five dogs after an intravenous injection of metoclopramide (Reglan), which caused a significant short-term increase in the intensity of the basic jejunal contractions and barium propulsion. Pressure manometry studies using intraluminal pressure transducers were performed, revealing an inherent baseline contractility. Each dog has its own individual pattern of activity. The pressure generated by the contractions ranged from 5 to 350 mm Hg. Intravenous injection of Reglan produced a marked increase in pressure, but no change in the frequency of contractions. This study suggests that a free jejunal graft will maintain baseline motility. However, this graft may cause dysphagia by discoordination of contractions, retrograde propulsion of a bolus, or a sustained local contraction, demonstrating the clinical problems associated with free jejunal graft reconstruction of the cervical esophagus. Our results with Reglan suggest that it might be possible to improve the function of these grafts using pharmacologic agents.
AB - Reconstruction of pharyngoesophageal defects using free jejunal grafts has become an accepted technique of reconstruction. However, there are functional problems associated with the jejunal graft. We developed a canine model that allows us easy access to perform various studies on grafted jejunum, including videofluoroscopy and pressure manometry to determine baseline function. Using a microvascular technique, free jejunal grafts 10 to 30 cm in length were implanted in 11 mongrel dogs. The jejunal segments were implanted subcutaneously and exteriorized proximally and distally. The grafted dogs underwent videofluoroscopic studies. These studies revealed three different types of jejunal graft contractions of variable intensity: circumferential, longitudinal, and mixed. These contractions resulted in four patterns of barium movement: anterograde propulsion, retrograde propulsion, to-and-fro motion, and peristaltic propulsion. Videofluoroscopic studies were repeated on five dogs after an intravenous injection of metoclopramide (Reglan), which caused a significant short-term increase in the intensity of the basic jejunal contractions and barium propulsion. Pressure manometry studies using intraluminal pressure transducers were performed, revealing an inherent baseline contractility. Each dog has its own individual pattern of activity. The pressure generated by the contractions ranged from 5 to 350 mm Hg. Intravenous injection of Reglan produced a marked increase in pressure, but no change in the frequency of contractions. This study suggests that a free jejunal graft will maintain baseline motility. However, this graft may cause dysphagia by discoordination of contractions, retrograde propulsion of a bolus, or a sustained local contraction, demonstrating the clinical problems associated with free jejunal graft reconstruction of the cervical esophagus. Our results with Reglan suggest that it might be possible to improve the function of these grafts using pharmacologic agents.
KW - baseline
KW - free jejunal graft
KW - motility
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U2 - 10.1016/0196-0709(90)90120-K
DO - 10.1016/0196-0709(90)90120-K
M3 - Article
C2 - 2281843
AN - SCOPUS:0025598899
SN - 0196-0709
VL - 11
SP - 407
EP - 415
JO - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
JF - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
IS - 6
ER -