Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.
Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.
Am J Otolaryngol. 2021 Mar-Apr;42(2):102890. doi: 10.1016/j.amjoto.2020.102890. Epub 2021 Jan 5.
Describe a novel technique for repair of cervical esophageal discontinuity.
A 66-year-old female underwent hiatal hernia repair with a Nissen fundoplication. This was complicated by ischemic necrosis of the proximal stomach requiring urgent return to the operative suite for partial gastrectomy, esophageal diversion and subsequent esophagectomy repaired with a colonic interposition graft by Thoracic Surgery. This was further complicated by a cervical esophageal colonic anastomotic leak maturing to a cervical esophageal fistula and necessitating jejunostomy tube placement and consultation to Head and Neck Surgery.
Case report.
In a team approach with Otolaryngology and Thoracic Surgery, she underwent a unique, multilevel repair with a salivary bypass stent bridging the gap between the proximal esophagus and distal colonic conduit. Bilateral local advancement flaps were elevated using the skin lateral to the fistula on each side with a random blood supply pedicled medially. Each flap was rotated medially over the stent and imbricated at midline. Next, a left myogenous pectoralis flap was raised and rotated over the site of imbrication. Lastly, a split thickness skin graft from the thigh was harvested and sutured over the pectoralis flap. Three months postoperatively, the salivary bypass stent was removed and by five months, the fistula was completely closed. With cervical esophageal dilations bimonthly, the patient has graduated to an oral diet without need of her jejunostomy tube for nearly four months.
This case report describes a novel and efficacious solution to cervical esophageal discontinuity.
描述一种修复颈段食管连续性中断的新方法。
一位 66 岁女性因食管裂孔疝行 Nissen 胃底折叠术，术后发生近端胃缺血性坏死，需紧急返回手术室行部分胃切除术、食管转流术，随后胸外科行结肠间置术修复。这进一步导致颈段食管结肠吻合口漏，发展为颈段食管瘘，需要放置空肠造口管，并请头颈部外科会诊。
病例报告。
在耳鼻喉科和胸外科的团队合作下，她采用了一种独特的多层面修复方法，使用唾液旁路支架桥接近端食管和远端结肠移植物之间的间隙。在瘘管两侧用游离皮瓣，通过皮瓣内侧的随机血管蒂向内侧提升双侧局部皮瓣。将每个皮瓣向支架内侧旋转并在中线处交错。然后，游离左胸大肌肌皮瓣并旋转覆盖在交错部位。最后，从大腿取部分厚度的皮肤移植片，缝合在胸大肌瓣上。术后 3 个月取出唾液旁路支架，术后 5 个月瘘完全闭合。通过每两个月进行颈段食管扩张，患者已逐渐过渡到口服饮食，近四个月无需使用空肠造口管。
本病例报告描述了一种修复颈段食管连续性中断的新颖且有效的方法。
