Esophageal reconstruction using microvascular anastomosis to the thoracoacromial artery and cephalic vein

For reconstruction of the pharynx and cervical esophagus following pharyngolaryngoesophagectomy, free gut transfer revascularized to such cervical vessels as the cervical transverse artery and external jugular vein is commonly performed. However, for reconstruction of the esophagus in the cervicothoracic junction or anterior to the chest wall, using the cervical vessels has more disadvantages than using the vessels in the chest wall. Thus, we developed a method of using the throracoacromial artery and cephalic vein for vascular anastomoses of a free jejunal graft and report herein our results in six cases. Three of these cases underwent reconstruction for an esophageal defect anterior to the chest wall, while the other three underwent reconstruction of the thoracic esophagus using a colonic pedicle graft. Satisfactory results were obtained in five of the six cases. Therefore, we recommend the use of the thoracoacromial artery and cephalic vein in vascular anastomoses during a free gut transfer or colonic pedicle graft for reconstruction of the esophagus anterior to the chest wall.