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J Thorac Cardiovasc Surg 2008;135:1186-1187
© 2008 The American Association for Thoracic Surgery

Brief Communication

Use of a prefabricated pectoralis major muscle flap and pedicled jejunal interposition graft for salvage esophageal reconstruction after failed gastric pull-up and colon interposition

K. Robert Shen, MDa,*, William Gerald Austen, Jr., MDb, Douglas J. Mathisen, MDa

a Division of General Thoracic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Mass
b Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Mass

Received for publication March 23, 2007; accepted for publication August 14, 2007.

* Address for reprints: K. Robert Shen, MD, Division of General Thoracic Surgery, Mayo Clinic, 200 First St SW, Mayo Building 1263W, Rochester, MN 55905. (Email: shen.krobert@mayo.edu).

The first 20% of the full text of this article appears below.

Secondary reconstruction after failed esophageal surgery remains a challenging surgical problem. In circumstances when neither the stomach nor the small or large bowel is available or adequate as an esophageal replacement, skin or musculocutaneous flaps should be considered. We report a case of salvage esophageal reconstruction using a prefabricated muscle flap in combination with pedicled jejunum in a staged fashion that highlights some of the management issues in addressing this difficult clinical situation.

Clinical Summary

A 50-year-old man with a history of Barrett's esophagus was found to have invasive adenocarcinoma in the distal third of his esophagus during surveillance endoscopy. He underwent en bloc esophagogastrectomy with 3-field lymph node dissection. On the fourth postoperative day ischemic necrosis of the gastric conduit developed, and the distal third of the conduit was resected. The left colic artery was sclerotic, so an isoperistaltic right colon interposition graft was used to connect the cervical esophagus to the gastric conduit remnant. Two weeks later, a right-sided empyema developed, and the colon interposition graft . . . [Full Text of this Article]






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