Vertical Island Trapezius Myocutaneous Flap for Cervical Esophagoplasty

Abstract

Reconstruction of the cervical esophagus can be fraught with a variety of complications, such as fistula formation or stricture. Additional complicating factors may include local tumor recurrence, failed prior reconstruction, partial or total flap necrosis, and compromised tissues in an irradiated field. Once complications occur, the chance of a successful reconstruction in subsequent operations is greatly reduced. We report a case of a patient who had local tumor recurrence despite chemoradiotherapy necessitating cervical esophagectomy. Reconstruction of the esophagus was initially performed with a tubed anterolateral thigh flap, which was complicated by partial flap necrosis and salivary fistula. Since the patient was elderly and already had a pectoralis flap used in a previous operation, we elected to perform a vertical island trapezius myocutaneous flap as a salvage procedure to restore esophageal continuity. Postoperatively, the patient had no evidence of further fistula and was able to tolerate a regular diet.