PMC9869483_01
Preoperative visual inspection, esophagography and CT. (A) Visual inspection of external neck skin and esophageal cutaneous fistula; (B) Left lateral view from a barium swallow shows ingested barium extravasated from a perforation (red arrows) into extraluminal space with the lower part of the esophagus not visible, indicating esophageal stenosis and fistula. (C) CT shows the esophageal cutaneous fistula (yellow arrows). (D) CT shows the lower end of esophageal stricture (blue arrows) in T5.
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F1
On physical examination, a cervical anastomotic fistula with gastric juice discharge was observed on the suprasternal fossa (Figure 1A). Esophagography in the other hospital revealed a stricture and leakage behind the sternum (Figure 1B). T5 and a fistula between the esophageal lumen and skin (Figures 1C,D). Thus, the diagnosis concluded to cervicothoracic esophageal stenosis with a fistula after esophagectomy.
The preoperative Schematic diagram of designing of pedicled TAAP flap and the reconstruction process for this case. (A) Designing of a PTTA flap. (B) The flap was sutured to the residual esophagus.
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F2
The flap size can be tailored up to 6 cmx12 cm, with a mean thickness of 0.5 cm. The vascular pedicle of the flap can be identified by an intersection of a line joined from the acromion to the xiphoid process and a perpendicular line drawn from the midclavicular point preoperatively (Figure 2).
Stricture resection and reconstruction of the esophageal defect using a pedicled TAAP flap. (A) The defects of cervical and thoracic esophagus. (B) Design of a pedicled TAAP flap. (C) The harvesting of a pedicled TAAP flap. (D) Reconstruction of the defect of cervical and thoracic esophagus using a pedicled TAAP flap and thoraco-acromial artery (blue arrow)
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F3
The wound of the donor site was closed directly (Figure 3). The total operative duration was approximately 5 h.
Postoperative visual inspection, esophagography and CT scan. (A) Postoperative visual inspection of external neck skin. (B) Esophagography shows the function of the reconstructed esophagus at the second month postoperatively. (C) CT shows the spacious reconstructed esophagus at the second month postoperatively.
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F4
Esophagography and CT 2 months after the operation revealed a viable anastomosis site with wide patency (Figure 4).