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J Thorac Cardiovasc Surg 1998;115:1250-1254
© 1998 Mosby, Inc.

GENERAL THORACIC SURGERY

The Utility Of The Pectoralis Myocutaneous Flap In The Management Of Select Cervical Esophageal Anastomotic Complications

From the Departments of Surgery and Otolaryngology Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.

Received for publication July 3, 1997. Revisions requested Oct. 6, 1997; revisions received Feb. 9, 1998. Accepted for publication Feb. 11, 1998. Address for reprints: Richard F. Heitmiller, MD, Osler 624, Johns Hopkins Hospital, Baltimore, MD 21287-5674.

Objective: The majority of cervical esophageal anastomotic complications can be successfully managed nonoperatively. A small group of patients may have anastomotic strictures or leakage and fistula formation that are chronic and resistant to nonoperative therapy. The purpose of this study was to review our experience with the use of the pectoralis myocutaneous flap to treat these patients.
Methods: Since April 1992, four patients have undergone pectoralis myocutaneous flap repair of cervical esophageal anastomotic complications at our institution. Two patients had chronic strictures, one patient underwent prophylactic repair with a pectoralis myocutaneous flap to prevent stricture formation, and one patient had a chronic anastomotic fistula. The pectoralis myocutaneous flap was harvested in the standard fashion. The technique of anastomotic repair is described. The medical records were retrospectively reviewed to determine patient characteristics and our results.
Results: Two suture line leaks developed: one small, contained leak required no intervention, and the other resolved with cervical drainage. Pneumonia, seroma at the site of the pectoralis myocutaneous flap donor, transient hoarseness, and partial skin graft loss occurred in one case each. There were no deaths. Hospital stay ranged from 12 to 22 days. A good functional result was obtained in three patients.
Conclusion: Our results show that pectoralis myocutaneous flap repair of select cervical anastomotic complications is safe and well tolerated even in patients with complicated problems. (J Thorac Cardiovasc Surg 1998;115:1250-4)

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