Successful management of cervicoesophageal anastomosis leak after microsurgical esophageal reconstruction: a case report and review of the literature.

Abstract

Free visceral and, more recently, free fasciocutaneous flaps are becoming increasingly common for esophageal reconstruction. However, complications of free flap conduit ischemia, specifically anastomotic leak have not been frequently discussed in the literature. This article provides a detailed description of total esophageal reconstruction with an 18 x 8.5 cm tube free radial forearm flap. A clinically significant cervical anastomosis leak was contained and healed with an innovative surgical rearrangement of local muscle flaps and closed suction drainage. We discuss the literature associated with cervical anastomotic leaks after visceral reconstruction and adapt those principles to the unique physiology of free fasciocutaneous flaps to develop a simple but reliable salvage option. This approach should be considered by reconstructive surgeons when helping other surgeons to manage an anastomotic leak after a cervical esophageal reconstruction in a similar setting.