Fascial Patch Reconstruction of a Gastric Conduit Defect Using an Anterolateral Thigh–Vastus Lateralis Composite Free Flap: A Case Report

Gastric conduit defects are difficult to manage when primary repair fails and the residual wall becomes friable, particularly in the setting of chronic infection and chest-wall tissue loss. We report a 71-year-old man with a retrosternal gastric conduit who sustained a full-thickness rupture during median sternotomy for coronary artery bypass grafting. Primary repair failed, resulting in chronic recurrent dehiscence and sternal wound infection. Debridement and partial resection of infected sternum and manubrium left a 3 × 2 cm noncircumferential conduit defect with adjacent presternal and mediastinal dead space. A 25 × 8 cm anterolateral thigh-vastus lateralis composite free flap was harvested with a thin fascial extension contiguous with the vastus lateralis muscle. The fascia was sutured around the entire defect perimeter as a tension-free primary patch. The vastus lateralis muscle was positioned over the repair for vascularized reinforcement and dead-space obliteration, while the skin paddle provided external coverage and flap monitoring. The flap was transferred to the right transverse cervical artery and branches of the internal jugular vein. No flap-related complications occurred. Esophagography at 4 weeks showed no leakage; full oral feeding was achieved by 6 weeks. At 10 months, swallowing symptoms remained at the preoperative post-esophagectomy baseline, with smooth contrast passage and no functional obstruction on videofluoroscopy. This case shows the feasibility of component-specific composite free-flap reconstruction for a limited gastric conduit defect.