Surgical salvage of failed esophageal reconstruction attempted with gastric pedicle

Use of the gastric pedicle is an established method for esophageal reconstruction. However, fistula or necrosis of the pedicle occasionally occur due to vascular insufficiency or the severity of the surgery. During the past 4 years, the authors encountered six patients with necrosis of the gastric pedicle, who required reconstruction of circumferential defects of the cervical and thoracic esophagus. In such secondary reconstructive cases, primary closure of the wound is very difficult because the surrounding soft tissue becomes fibrous from infectious and fistulous complications of the first operation. Free jejunal transfers were utilized for restoring continuity of the alimentary tract, a platysma myocutaneous and pectoral fasciocutaneous flap for covering the intestinal anastomoses, and a mesenteric flap connected with the jejunal graft for covering the remaining skin defects in these cases. In follow-up periods from 3 to 21 months, satisfactory results were obtained in all but one patient. Five patients could eat a normal diet without difficulty. This reconstructive method is advocated as safe and well-tolerated physiologically in the salvage of necrosis of the gastric pedicle.