Simultaneous Reconstruction of the Esophagus and Posterior Tracheal Wall Using a Combination of Free Jejunal and Mesenteric Flaps: A Case Report

Abstract

Free jejunal transfer is one of the most useful procedures for reconstructing circumferential defects following total pharyngolaryngoesophagectomy (TPLE). When an extended resection of the surrounding soft tissue is performed in addition to the TPLE, the defect may require another flap in addition to the jejunal flap to reconstruct the soft tissue defect. In such multiple defects, the choice of reconstruction method remains unanswered and unsolved. Herein, our objective was to clarify the utility of our newly developed technique of simultaneous reconstruction of two defects in the neck using a combination of free jejunal and mesenteric flaps. An 81-year-old man had defects in the upper esophagus, total larynx/pharynx, and posterior tracheal wall caused by the resection of invasive upper esophagus cancer anterior to the membranous part of the trachea. A chimera flap composed of a 15 cm free jejunal and mesenteric flap along with 15 cm of surplus mesentery was harvested; the jejunum was inserted into the esophageal defect and the mesentery was placed on the tracheal defect. The patient exhibited a favorable postoperative course at 8 months with no recurrence or stenosis in the reconstructed respiratory or gastrointestinal tract. This method offers a straightforward vessel anastomosis, making it a good and reasonable option for reconstructing partial tracheal defects along with TPLE.