Microsurgical reconstruction of the esophagus

The loss or stricture of the esophagus has a tremendous impact on daily life. Before the era of microsurgery, many patients had to rely on tube feeding from jejunostomy following failure of esophageal reconstruction with conventional methods. Since the application of microsurgery, almost all kinds of esophageal defects can be reconstructed successfully with microvascular transfer of jejunum, colon, and skin flaps. Microsurgery is also used to augment the blood supply for the pedicled colon and jejunum flaps. In 97.6% of cases, successful reconstruction has been achieved. The leakage rate and functional results are evaluated for each group. For the pharynx and cervical esophagus, jejunum is the best choice. For replacement of the thoracic esophagus, a pedicled colon flap is the first choice, but it can be supercharged with microvascular anastomoses to the neck vessels if necessary. We conclude that the microsurgical transfer of jejunum, colon, and skin flaps is a useful approach for reconstruction of the esophagus. With proper selection of the organ substitute and correct inset of the flap, it not only provides anatomical replacement, but also a superior functional result. Free jejunum flap transfer requires attention to flap length and duration of ischemia. Free colon flap transfer requires attention to arteriosclerotic changes and the vascular pattern. Free skin flaps require attention to leakage prevention. Semin. Surg. Oncol. 19:235-245, 2000.