Repairing esophageal perforations with a transverse cervical musculofascial flap

Objectives/Hypothesis: Although rare, perforations of the esophagus following spinal surgery via an anterior approach are serious life-threatening problems. Complications include abscess formation, mediastinitis, sepsis, and fistula that can carry a mortality rate of 20%-50%. Early diagnosis and treatment are imperative. A common method of repair is isolation and primary repair of the defect in the esophagus, with interpositional muscle coverage. A transverse cervical myofascial artery flap is described here as a potential reconstructive option. Study Design/Methods: Retrospective review was performed on 3 patients who had repair of esophageal perforations following spinal surgery with an anterior approach. Results: In all 3 cases, hardware was found to be eroding through the esophagus. The hardware was removed at the time of repair and flap coverage in 2 patients, and each went on to an oral diet within 10 days without complication, with follow-up exceeding 6 months. A third patient with recurrent erosions could not have the hardware removed and subsequently suffered with another erosion through the muscle flap. A secondary surgery with pectoralis flap coverage was successful but required revision surgeries for flap debulking. No patients had limitation of shoulder movement after flap reconstruction, and all went on to a normal diet without dysphagia. Conclusions: The transverse cervical artery musculofascial flap can be an ideal method for repair of small cervical esophageal perforations, although spinal hardware should be removed if felt to be the etiology of the perforation.