Esophageal replacement in the dog by microvascular colon transfer.

An orthotopic colon graft based on the middle colic artery and vein was implanted with microvascular technique and a stapling instrument in five dogs. The grafts were successful in four dogs. A similar colon autograft was used to replace the entire thoracic esophagus in five dogs. The recipient vessels were the left carotid artery and left external jugular vein. Four of the grafts failed because of kinking and thrombosis of the arterial supply (2 dogs) or the venous outflow (2 dogs). One graft, which had a viable vascular supply, developed a severe leak at the colon-to-stomach anastomosis, and the dog was euthanatized on day 3. The recipient vascular pedicle was modified and used successfully to replace a portion of the cervical esophagus in three dogs. The grafts survived, the dogs could swallow liquids and semisolid food well, and, at necropsy after 4 weeks, the anastomotic sites were well healed. The graft sites contained essentially normal colon mucosa.