ABSTRACT
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.
