title: Delayed hypopharyngeal and esophageal perforation after anterior spinal fusion: primary repair reinforced by pedicled pectoralis major flap.
abstract: METHODS
  This report documents a case of delayed hypopharyngeal and esophageal perforation after anterior spinal fusion and reviews relevant literature.
  
  
  OBJECTIVE
  Presentation of an alternative solution of primary repair and reinforcement of a delayed esophageal and hypopharyngeal perforation after anterior spinal fusion.
  
  
  BACKGROUND
  Anterior plating is generally used for stabilization after cervical spine trauma. Esophageal and hypopharyngeal perforation is a rare but potentially life-threatening complication due to mediastinitis with consecutive septic shock and multiorgan failure.
  
  
  METHODS
  Our patient was operated on after cervical trauma caused by car accident. The neurologic condition did not improve in the postoperative period. About 4 months later, the patient had increasing dysphagia as well as episodes of odynophagia. Flexible esophagoscopy showed a perforation of a part of the plate from the hypopharynx down to the proximal esophagus. Primary repair reinforced by a pedicled pectoralis major flap was done without complications.
  
  
  RESULTS
  Postoperative fluoroscopy as well as endoscopy showed no signs of perforation. Swallowing was possible without any further episodes of dysphagia or odynophagia. Neck movement was unconfined.
  
  
  CONCLUSIONS
  Primary repair reinforced by pedicled pectoralis major flap has been shown to be an alternative in case of combined hypopharyngeal and esophageal perforation due to orthopedic spine stabilization. Advantage of the pectoralis major muscle flap is no functional loss of neck movement.
authors.affiliation: Department of Traumatology, Medical University of Graz, Graz, Austria. wolfgang.pichler@klinikum-graz.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pichler
authors.forename: Alfred
authors.initials: A
authors.lastname: Maier
authors.forename: Thomas
authors.initials: T
authors.lastname: Rappl
authors.forename: Hans Gunther
authors.initials: HG
authors.lastname: Clement
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Grechenig
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D004939:Esophageal Perforation / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007013:Hypopharynx / Q000293:injuries*; D008297:Male; D010369:Pectoralis Muscles / Q000637:transplantation*; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000473:pathology / Q000601:surgery