THE PECTORALIS MAJOR MYOCUTANEOUS FLAP COMBINED WITH FREE JEJUNAL TRANSFER FOR AERODIGESTIVE TRACT RECONSTRUCTIONS

Occasionally carcinomas of the proximal third of the esophagus invade the trachea. In these cases potential cure or adequate palliation can only be achieved by extensive resection of the hypopharynx, the proxim al esophagus and the trachea. Sometimes the sternal manubrium has to b e removed to obtain adequate margins of resection. Under these circums tances reconstruction of the digestive tract and creation of a properl y functioning tracheal stoma can be challenging. A procedure is descri bed in which a mediastinal tracheal stoma is created by centering the terminal portion of the trachea in a pectoralis myocutaneous flap afte r resection of the sternal manubrium. Digestive tract reconstruction i s achieved by free jejunal transfer. For high thoracic carcinomas the manubrectomy allows resection via a proximal route and facilitates rec onstruction. Similarly the integrity of the distal esophagus and stoma ch can be maintained. The technique is illustrated in two patient repo rts.