Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas, such as hypopharyngea I carcinoma with thoracic esophageal carcinoma. However, neck circumferential defect and tracheoesophageal fistula alter gastric necrosis are still challenging problems for surgeons and patients. CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using local random flaps with a split thickness skin graft in the first case, and 6 ilocal random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up. Both patients achieved good swallowing function and could take solid diet without dvsphagia postoperatively. CONCLUSION For selected patients, local random flaps (with a split thickness skin graft) can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis, especially when the necrosis extends below the thoracic inlet.