Use of the radial forearm free tissue flap to treat persistent stricture after esophagogastrectomy

Background: Persistent stricturing or anastomotic leakage at the cervical e sophagogastric anastomosis can be a troublesome complication of gastric pul l-up procedures. When the stricture is the result of ischemia of the stomac h, the strictures are long and often not responsive to dilatation and requi re large operations such as jejunal interposition or replacement with colon ic pull-up. In this report we describe the use of a radial forearm flap to patch strictures. Methods: The radial forearm flap is a fascia cutaneous flap taken from the forearm and based on the radial artery and its venae comitantes. The advant ages of this flap are that it is thin and pliable, conforms easily, has exc ellent reliability due to the size of the feeding vessels, and has a relati vely long pedicle. The vascular anastomosis can be made to several arteries and veins within the neck. The epithelial component can be made in sizes u p to 10 by 20 cm. Results: We have used the radial forearm flap to patch strictures in 6 pati ents with persistent complex strictures in the cervical region after esopha gectomy. Results were excellent in 4 patients (able to eat liquids and soli ds without problems) and good in 1 patient (liquids okay, some problem with solids), and 1 patient died postoperatively. Follow-up is 4 months to 7 ye ars. Conclusions: The radial forearm flap is an excellent option for handling pe rsistent stricture after esophagogastrectomy. In many instances, this flap can be used in lieu of a jejunal interposition flap and obviates a laparoto my to harvest jejunum. The flap fits easily into the neck and conforms to t he space. (C) 2001 Excerpta Medica, Inc. All rights reserved.