Reconstruction of the Esophageal Defect

For reconstruction of esoghageal defects the conventional methods includ pedicled stomach or gastric tube, pedicled colon segment interposition, pedicled skin or musculocutaneous flaps (e.g., pectoralis major, trapezius , latissimus dorsi, Bakamjian flap, platysma flap, etc.), skin graft method, direct application of neck skin for cervical esophageal prosthesis . Microsurgical methods include free jejunum flap, free colon flap, free stomach flap, free skin flap (e.g., forearm flap, anterolateral thigh flap , etc.), and supercharge of vessels to augment the blood supply for the pedicled flaps that are used in conventional methods. Conventional procedures are always selected first. If they cannot accompolsh the reconstrruction of esophageal defects, microsurgical transfer is considered. A free flap is also indicated when it provides better function than conventional methods. Esophageal reconstruction with associated reconstruction of voice and trachea is required in more complex defects, such as that of total pharyngolaryngectomy after cancer ablation. If necessary, conventional methods can be combined with microsurgery for reconstruction of difficult cases, such as supercharge of artery or vein for a pedicled colon segment, various method of prefabrication before free tissue transfer, and so forth. Physiotherapy for swallowing and speech helps to obtain quick return of good functions, and proper education helps to avoid possible complications.