Tubed Deltopectoral Flap for Creation of a Controlled Esophagocutaneous Fistula in Patients With Persistent Choking Following Esophageal Reconstruction With Free Diversionary Jejunum

In Brief Esophageal reconstruction in patients with abnormal pharyngeal muscles or epiglottis may result in episodes of choking. The jejunal flap has been used to prevent choking by insetting the proximal end into the gingivobuccal sulcus and separating the digestive tract from the airway. A technique has been developed to deal with patients with aspiration due to collection of food near the nonfunctioning epiglottis. Between 1997 and 2004, 25 patients underwent reconstruction with jejunal flaps inset into the gingivobuccal sulcus. Postoperatively, 5 patients presented with episodes of choking. All patients underwent creation of an esophagocutaneous fistula using a deltopectoral flap. All flaps survived. Choking resolved and vocal performance was preserved in all patients. The jejunum, inset proximally into the gingivobuccal sulcus, has been successful in reconstructing patients unable to separate the airway from the digestive tract. The deltopectoral flap provides tissue for creation of a tubed flap and allows for the creation of a long fistula that prevents aspiration and can divert oral fluids away from a tracheostomy or a fresh wound. Five patients with episodic choking following jejunal transfer for esophageal reconstruction were successfully relieved by creation of an esophagocutaneous fistula using a tubed deltopectoral flap that diverted oral fluids away from the nonfunctioning epiglottis.