THE UTILITY OF THE PECTORALIS MYOCUTANEOUS FLAP IN THE MANAGEMENT OF SELECT CERVICAL ESOPHAGEAL ANASTOMOTIC COMPLICATIONS

Objective: The majority of cervical esophageal anastomotic complicatio ns can be successfully managed nonoperatively, A small group of patien ts may have anastomotic strictures or leakage and fistula formation th at are chronic and resistant to nonoperative therapy. The purpose of t his study was to review our experience with the use of the pectoralis myocutaneous Bap to treat these patients. Methods: Since April 1992, f our patients have undergone pectoralis myocutaneous flap repair of cer vical esophageal anastomotic complications at our institution. Two pat ients had chronic strictures, one patient underwent prophylactic repai r with a pectoralis myocutaneous flap to prevent structure formation, and one patient had a chronic anastomotic fistula. The pectoralis myoc utaneous flap was harvested in the standard fashion. The technique of anastomotic repair is described. The medical records were retrospectiv ely reviewed to determine patient characteristics and our results. Res ults: Two suture line leaks developed: one small, contained leak requi red no intervention, and the other resolved,vith cervical drainage. Pn eumonia, seroma at the site of the pectoralis myocutaneous flap donor, transient hoarseness, and partial skin graft loss occurred in one cas e each. There were no deaths. Hospital stay ranged from 12 to 22 days. A good functional result was obtained in three patients. Conclusion: Our results show that pectoralis myocutaneous flap repair of select ce rvical anastomotic complications is safe and well tolerated even in pa tients with complicated problems.