title: Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report.
abstract: Reconstruction of late esophageal perforation usually requires flap surgery to achieve wound healing. However, restoring the continuity between the digestive tract and retropharyngeal space to allow for normal swallowing remains a technical challenge. In this report, we describe the use of a thin and pliable free adipofascial anterolateral thigh (ALT) flap in a 47-year-old tetraplegic man with a history of C5-C6 fracture presented with a large posterior esophagus wall perforation allowing an easier flap insetting for a successful wound closure. The postoperative course was uneventful and mucosalization of the flap was confirmed by esophagoscopy 4 weeks postsurgery. The patient tolerated normal diet and maintained normal swallowing during a follow-up of 3 years postoperatively. The adipofascial ALT flap may provide easier insetting due to the thin and pliable layer of adipofascial tissue for reconstructing large defects of the posterior wall of the esophagus by filling the retroesophageal space.
authors.affiliation: Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Ruben
authors.initials: R
authors.lastname: Coelho
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Ekberg
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Svensson
authors.affiliation: Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0002-5387-6343
authors.initials: M
authors.lastname: Mani
authors.affiliation: Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Andres
authors.identifier: http://orcid.org/0000-0003-2953-5634
authors.initials: A
authors.lastname: Rodriguez-Lorenzo
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005205:Fascia / Q000637:transplantation; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013848:Thigh / Q000601:surgery; D016896:Treatment Outcome