Free Tissue Transfer for Repair of Chronic Esophageal Perforations

Matthew Helton; James Reed Gardner; Quinn Dunlap; T Glenn Pait; Jumin Sunde; Emre Vural; Mauricio Alejandro Moreno

doi:10.1177/2473974X211031472

Free Tissue Transfer for Repair of Chronic Esophageal Perforations

OTO Open. 2021 Jul 20;5(3):2473974X211031472. doi: 10.1177/2473974X211031472. eCollection 2021 Jul-Sep.

Authors

Matthew Helton¹, James Reed Gardner², Quinn Dunlap², T Glenn Pait¹, Jumin Sunde², Emre Vural², Mauricio Alejandro Moreno²

Affiliations

¹ Department of Neurosurgery, Jackson T. Stephens Spine and Neuroscience Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
² Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Abstract

Objective: Anterior cervical discectomy and fusion have become a common intervention for cervical spine stabilization. However, complications can cause life-threatening morbidity. Among them, esophageal perforation is associated with severe morbidity, including dysphagia, malnutrition, and infection with the potential development of mediastinitis. Presentation is variable but often results in chronic morbidity. Herein we examine our experiences in the management of esophageal perforation with microvascular free tissue transfer.

Study design: Retrospective review from January 2013 to September 2020.

Setting: Single academic tertiary care center.

Methods: This study comprised all patients (age, 41-73 years) undergoing free tissue transfer for the repair of chronic esophageal perforation secondary to anterior cervical discectomy and fusion at an academic tertiary care center. Four patients underwent repair via vastus lateralis myofascial onlay grafting for defects ≤2 cm in greatest dimension, while 1 patient underwent a fasciocutaneous radial forearm free flap repair of an 11 × 5-cm defect.

Results: Defect location ranged from hypopharynx to cervical esophagus. Mean operative time was 6.2 hours; the average length of stay for all patients was 6.6 days. Of 5 patients, 1 required additional hardware placement for spine stabilization. All patients underwent gastrostomy tube placement to bypass the surgical site during healing, and all eventually resumed an oral diet postoperatively. Recurrent fistula occurred in 1 of 5 patients. No flap failures were encountered in the study population.

Conclusion: Vastus lateralis myofascial onlay grafting and fasciocutaneous radial forearm free flap are robust, relatively low-morbidity interventions with a high success rate for definitive repair of chronic esophageal perforation. Repair should be undertaken in concert with a spine surgeon for management of the cervical spine.

Keywords: cervical spine; esophageal perforation; fasciocutaneous radial forearm free flap; free tissue transfer; vastus lateralis myofascial onlay graft.