title: Flexing the neck relieves tension on cervical esophageal anastomosis.
abstract: BACKGROUND
  The conventional method of bridging anatomic defects of the upper digestive tract in the neck is by tissue transfer--either gastric or colon pull-through, free jejunal graft, or full-thickness skin flaps. An alternative way of closing such defects is to flex the neck. This moves the remnant proximal esophagus or pharynx a considerable distance downwards--a standard tension-releasing maneuver in tracheal resection and reconstruction.
  
  
  METHODS
  Neck flexion was used in 7 patients grouped into three separate surgical conditions: A) in two patients after esophagectomy, where the pulled-up stomach would not reach the remnant proximal esophagus or the pharynx; B) in three patients where the defect after removal of the diseased portion of the cervical esophagus measured 4.5, 5.0, and 8.0 cm, respectively; and C) in 2 patients with 4.5- and 1.5-cm long circumferential postoperative esophageal strictures managed by Heineke-Miculicz repair.
  
  
  RESULTS
  No postoperative cervical fistulas were seen. One patient, whose 8-cm long cervical esophageal defect had been closed by end-to-end anastomosis, developed a stricture.
  
  
  CONCLUSIONS
  In special situations, flexing the neck allows for safe anastomosis or closure of esophageal defects in the neck, obviating the need for tissue transfer.
authors.affiliation: Department of Surgery, Modarress Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Noureddin
authors.initials: N
authors.lastname: Pirmoazen
authors.forename: Morteza
authors.initials: M
authors.lastname: Seirafi
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Javaherzadeh
authors.forename: Farrokh
authors.initials: F
authors.lastname: Saidi
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004940:Esophageal Stenosis / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology*; D010614:Pharynx / Q000473:pathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D013270:Stomach / Q000473:pathology; D014132:Trachea / Q000601:surgery*