A new technique for esophageal reconstruction by combined skin and muscle flaps after failure in primary colonic interposition.

A new procedure is presented for esophageal reconstruction using the skin flap combined with the overlying muscle flap in a situation in which preceding cervical esophagostomy and antesternal colostomy have been performed. A conventional musculocutaneous flap may be used for the second stage of the operation. However, our method has several advantages. The skin canal, which is the most important part of this reconstruction, is created using the skin of the anterior chest wall without transferring cutaneous tissue from other places. Therefore, the operative procedure becomes simpler and the blood supply to the skin canal is more assured. While blood of the wall of the canal is supposed to be supplied initially from internal mammary and intercostal arteries, the muscle flap over the canal may subsequently provide more blood to the skin canal. In addition to sufficient blood supply, the length of a suture line for creating the skin canal is minimal, and, thereby, the possibility of postoperative leakage can be diminished. Because both esophagostoma and colostoma are not damaged in the second stage of the operation, strictures at these sites are not likely to occur. Furthermore, the muscle flap serves as a physical protector for the canal, and presents a suitable bed for the split thickness graft. Our two stage operation using combined skin and muscle flaps after antesternal colostomy is a safe, simple and assured technique for the compromised colonic segment at primary esophageal reconstruction. This procedure is also applicable to the patient in whom use of a stomach tube for esophageal replacement is attempted but primary cervical esophagogastrotomy is not possible.