Reconstructive surgery of the cervical esophagus.

Free heterotopic transplantation of segments of the distal alimentary tract revascularized in the neck provide a very satisfactory, straightforward method of reconstruction of the cervical esophagus. At present pharyngoesophageal reconstructions are of four major types: (1) free skin grafts; (2) local or regional skin flaps; (3) subcutaneous or intrathoracic interposition or migration on a vascular pedicle of more distal positions of the alimentary tract--stomach or colon; and (4) a free graft of jejunum or colon. This report is an account of each of these methods with an emphasis on free revascularized grafts of the jejunum. Fifty-five such reconstructions have been performed at Emory Affiliated Hospitals. There were six graft failures for a transfer reliability of 90%. There were three perioperative deaths for a perioperative mortality of 5%. Comparison with similar reported series using either direct esophagogastric anastomosis, colon interposition, or staged deltopectoral skin flap reconstruction would suggest that the free jejunal graft procedure has lower morbidity and mortality. I believe it to be the method of choice in reconstruction of the cervical esophagus.