The pectoralis major myocutaneous flap combined with free jejunal transfer for aerodigestive tract reconstructions

Abstract

Occasionally carcinomas of the proximal third of the esophagus invade the trachea. In these cases potential cure or adequate palliation can only be achieved by extensive resection of the hypopharynx, the proximal esophagus and the trachea. Sometimes the sternal manubrium has to be removed to obtain adequate margins of resection. Under these circumstances reconstruction of the digestive tract and creation of a properly functioning tracheal stoma can be challenging. A procedure is described in which a mediastinal tracheal stoma is created by centering the terminal portion of the trachea in a pectoralis myocutaneous flap after resection of the sternal manubrium. Digestive tract reconstruction is achieved by free jejunal transfer. For high thoracic carcinomas the manubrectomy allows resection via a proximal route and facilitates reconstruction. Similarly the integrity of the distal esophagus and stomach can be maintained. The technique is illustrated in two patient reports.