SURGICAL SALVAGE OF FAILED ESOPHAGEAL RECONSTRUCTION ATTEMPTED WITH GASTRIC PEDICLE

Use of the gastric pedicle is an established method for esophageal rec onstruction. However, fistula or necrosis of the pedicle occasionally occur due to vascular insufficiency or the severity of the surgery. Du ring the past 4 years, the authors encountered six patients with necro sis of the gastric pedicle, who required reconstruction of circumferen tial 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 an d fistulous complications of the first operation. Free jejunal transfe rs were utilized for restoring continuity of the alimentary tract, a p latsyma myocutaneous and pectoral fasciocutaneous flap for covering th e intestinal anastomoses, and a mesenteric flap connected with the jej unal graft for covering the remaining skin defects in these cases. In follow-up periods from 3 to 21 months, satisfactory results were obtai ned in all but one patient. Five patients could eat a normal diet with out difficulty. This reconstructive method is advocated as safe and we ll-tolerated physiologically in the salvage of necrosis of the gastric pedicle.