Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

doi:10.12998/wjcc.v9.i33.10328

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World Journal of Clinical Cases

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World J Clin Cases. Nov 26, 2021; 9(33): 10328-10336
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10328

Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

Ye Zhang, Yang Liu, Yu Sun, Meng Xu, Xiao-Lei Wang

Ye Zhang, Yang Liu, Yu Sun, Meng Xu, Xiao-Lei Wang, Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Author contributions: Wang XL designed the report; Zhang Y and Liu Y collected the clinical data; Zhang Y reviewed the literature and wrote the manuscript; Wang XL, Sun Y, and Xu M edited and revised the manuscript; All authors read and approved the final manuscript.

Informed consent statement: All study participants provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Xiao-Lei Wang, MD, Attending Doctor, Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. wangxlchcams@163.com

Received: July 10, 2021
Peer-review started: July 10, 2021
First decision: July 26, 2021
Revised: August 8, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: November 26, 2021
Processing time: 134 Days and 21 Hours

Abstract

BACKGROUND

Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas, such as hypopharyngeal carcinoma with thoracic esophageal carcinoma. However, neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.

CASE SUMMARY

This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case, and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up. Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.

CONCLUSION

For selected patients, local random flaps (with a split thickness skin graft) can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis, especially when the necrosis extends below the thoracic inlet.

Keywords: Local random flap; Cervical circumferential defect reconstruction; Tracheoesophageal fistula reconstruction; Failed gastric pull-up; Total pharyngo-laryngo-esophagectomy; Case report

Core Tip: In this paper, we report 2 patients who suffered from cervical circumferential defect and tracheoesophageal fistula, reconstructed with local random flaps (with a split thickness skin graft in the first case), after failed gastric pull-up. Both patients achieved good swallowing function without dysphagia postoperatively. Local random flaps and split thickness skin graft have the advantages of easy to harvest with abundant and flexible donor sites. Herein, local random flaps (with a split thickness skin graft) can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis.