Jejunal artery and vein positioning in free jejunal transfer: Surgical considerations and clinical implications

Background: Previous computed tomography studies have reported that the superior mesenteric artery is often located ventrally to the superior mesenteric vein; however, the precise location of the peripheral jejunal arteriovenous system is unknown. This study investigated the arteriovenous positioning of the free jejunal flaps during reconstructive surgery.

Methods: This retrospective cohort study included 78 patients who underwent free jejunal flap reconstruction between June 2021 and May 2023. The positions of the jejunal artery and vein were classified into 6 patterns (A-F) based on the photographs taken during the flap harvest. Statistical analysis was performed to examine the location of the artery (ventral vs. dorsal) and its orientation along the oral-anal axis in relation to the vein.

Results: The jejunal arteries were most commonly located on the oral and ventral sides of the vein (type A, 48.6%) when the mesentery of the jejunal flap is positioned toward the front, with the left and right sides corresponding to the oral and anorectal sides, respectively. Notably, 62.1% of the arteries were located on the oral side and 71.6% on the ventral side. The recipient arteries used for vascular anastomosis were predominantly the superior thyroid artery (44.6%) and transverse cervical artery (50.0%), while the internal jugular vein (85.1%) was the most commonly used vein.

Conclusion: The position of the jejunal arteriovenous system is important for optimizing anastomotic techniques and ensuring safe surgical outcomes. Understanding vascular anatomy patterns can help prevent vessel misplacement and allow for more reliable and accurate anastomosis procedures.