Preexpanded Perforator Flaps for Neoesophageal Reconstruction after Bipolar Upper Gastrointestinal Tract Exclusion

Area of Science:

• Surgical innovation in reconstructive surgery.
• Gastroenterology and surgical oncology.

Background:

• Total esophageal reconstruction is challenging, especially in patients with prior surgeries and complex conditions.
• Conventional methods like gastroplasties and colon transfers have high failure rates and morbidity.

Purpose of the Study:

• To introduce and evaluate an innovative four-step strategy for esophageal reconstruction.
• To assess the safety and efficacy of a presternal skin tube technique in high-risk patients.

Main Methods:

• A four-step strategy involving chest skin expansion, perforator flap tubularization, and double anastomosis was employed.
• Six patients with previous reconstruction failures underwent this presternal neo-esophagus creation.
• Techniques included tissue expanders and internal mammary perforator flaps.

Main Results:

• All six patients achieved restoration of digestive tract continuity.
• Minor complications like fistulas and wound dehiscence resolved without significant intervention.
• Patients tolerated a diet progression to solids within 2-3 months, with long-term lumen integrity confirmed.

Conclusions:

• The described staged reconstruction is a viable and safe alternative for total esophageal replacement in complex, high-risk cases.
• The presternal neo-esophagus offers acceptable function and manageable complications, avoiding further intrathoracic surgery.