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Ann Thorac Surg 2009;87:647-649. doi:10.1016/j.athoracsur.2008.06.045
© 2009 The Society of Thoracic Surgeons
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Esophagectomy and Gastric Pull-Up in Patients With Previous Free Jejunal Transfer

Yoshinori Hosoya, MD, PhDa,*, Shunji Sarukawa, MD, PhDb, Shiro Matsumoto, MD, PhDa, Toru Zuiki, MD, PhDa, Masanobu Hyodo, MD, PhDa, Koichi Abe, MD, PhDc, Hiroshi Nishino, MD, PhDc, Yasushi Sugawara, MD, PhDb, Alan T. Lefor, MD, MPHa, Yoshikazu Yasuda, MD, PhDa

a Department of Surgery, Jichi Medical University, Tochigi, Japan
b Department of Plastic and Reconstructive Surgery, Jichi Medical University, Tochigi, Japan
c Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Tochigi, Japan

Accepted for publication June 9, 2008.

* Address correspondence to Dr Hosoya, Department of Surgery, Jichi Medical University, 3311-1 Shimotsuke, Tochigi, 329-0498 Japan (Email: hosoyo{at}jichi.ac.jp).

Several options exist for reconstruction after total esophagectomy in patients with esophageal carcinoma. However, the options for a major resection after previous head and neck surgery in these patients are extremely limited. The procedure performed in 2 patients requiring esophagectomy after resection for previous head and neck malignancies is described. Both patients underwent previous chemoradiation therapy and free jejunal transfer for hypopharyngeal squamous cell carcinoma. Esophagectomy and reconstruction with a cervical gastrojejunal anastomosis combined with deltopectoral flaps were performed after the diagnosis of esophageal disease. Soft tissue defects were closed with a modified deltopectoral flap using de-epithelization. The deltopectoral flap is effective not only for cutaneous resurfacing, but also to promote delayed wound healing after radiation therapy. This report demonstrates a useful multidisciplinary approach for resection and reconstruction in patients after a previous free jejunal transfer.






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