J.Jpn. Surg. Soc.. 87(9): 1051-1055, 1986

---

Report on the annual meeting

HAZARDS IN CERVICAL ESOPHAGEAL RECONSTRUCTION WITH SKIN FLAP

It rarely happens that even gastroenterological surgeons secondarily choose skin flap for hight esophageal reconstruction. Other surgeons, plastic or otorhinolaryngeal, are more used to the skin. We have two groups (I and II) of cases in which skin flap was used for cervical esophageal reconstruction. The flap was of fixed type in group I and of free type (forearm flap) in group II. Problems met during operation and on the follow-up course up to 10 years are as follows.
(1) FORMATION OF SKIN TUBE. The free flap was superior to the fixed flap, as the longitudinal suture line can be brought into the transplantation bed in the fomer, not in the latter, (2) LENGTH OF TUBE. With a long tube distal anastomosis can be done on the chest wall, which is easier than procedure within neck. (3) THREE-POINT SUTURE. A known hazard going with a formed tube, not with a natural tube (intestinal loop). The leak at the three-point spot was controlled well, as it occurred with a free flap in the transplantation bed. (4) STOMAL STENOSIS＆GENERAL NARROWING. All cases in the long term folIow-up developed stomal stenosis and one long-tube case resulted in a general narrowing. The progress of narrowing was stopped by and the narrowed part is being dilated along with bouginage using various dilators. (5) FATE OF SKIN. The surface of the skin inside the tube appears reddened as the time lapsed after surgery. Biopsy taken at nearly 10 years after surgery has shown a mild degree of dermatitis and none cancerous. No untoward skin sensation is left with the free flap, because the nerves are cut.

---

---

To read the PDF file you will need Adobe Reader installed on your computer.