PS02.244: PEDICLED FLAPS IN ESOPHAGEAL SURGERY: WHERE THORACIC-, PLASTIC- AND ENT- SURGEONS MEET

Abstract

Abstract Background Esophageal, esophago-hypopharyngeal and esophago-tracheobronchial fistulae or strictures arising either de novo or following therapeutic interventions constitute serious therapeutic challenges. If conservative measures fail, pedicled muscular or myocutaneous flaps are life-saving assets. Methods During the last 10 years we treated 13 patients (11 males, 2 females; mean age: 59; range: 44–82y) with complex esophageal/hypopharyngeal problems by using pedicled muscle flaps. Results All had but one case of lye ingestion had underlying malignant disease, all but two of the latter had had chemo- and or radiotherapy. At the time of the intervention eight patients were in a critical, septic condition. There were 5 esophago-tracheal, 2 esophago-bifurcational, one esophago-colo-bronchial, and one hypopharyngo-tracheal fistula, as well as one pharyngo-cutaneous fistula all following resection/reconstruction and/or attempts of surgical closure. One patient had stricture following external irradiation, another one anastomotic stricture. We applied a total of 17 pedicled flaps: 10 pectoralis major flaps (7 of them myocutaneous, three split flaps), 5 deltoideo-pectoral myocutaneous flaps and 2 sternocleidomastoideus flaps. In 11 patients additional intermittent stenting was used. In 6 patients the respective condition healed, 4 patients could be discharged but had minor recurrent fistulae that could be handled conservatively, in three cases persisting sepsis and multiorgan failure could not be overcome. Conclusion Muscle flaps can be life-saving in large fistulae of the esophagus and the hypopharynx and are useful for refractory cervical stenosis. In presence of multiorgan dysfunction, however, healing of flaps however initially vital, is often impaired. Disclosure All authors have declared no conflicts of interest.