title: Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction.
abstract: Secondary reconstruction of thoracic esophageal defects is a challenging problem for microsurgeons. Because of previous surgeries and coexisting disease, gastric pull-up, and creation of a pedicled colon conduit are often impossible. Transfer of a supercharged pedicled jejunum flap or free jejunal interposition is usually the last resort; however, identifying appropriate recipient vessels and adequately covering the reconstructive conduit are often difficult. We performed secondary thoracic esophageal reconstruction with combined use of the cephalic vein as a recipient vein and the pectoralis major muscle flap for coverage in three patients. Two patients underwent transfer of a supercharged pedicled jejunum flap, and the other patient underwent free jejunal interposition. No wound complications occurred, and all patients could resume oral intake. The cephalic vein is a more reliable recipient vein than is the internal mammary vein. The skin graft-covered pectoralis major muscle flap provides secure external coverage to prevent anastomotic leakage even in complicated cases. Combined use of the cephalic vein and the skin graft-covered pectoralis major muscle flap is a versatile option for secondary thoracic esophageal reconstruction.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Kayano
authors.forename: Masahide
authors.initials: M
authors.lastname: Fujiki
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000637:transplantation; D016038:Skin Transplantation; D013524:Surgical Flaps; D014680:Veins / Q000601:surgery