Closure of esophageal defects with muscle flaps
J. D. Richardson and G. R. Tobin
Department of Surgery, University of Louisville, School of Medicine. Ky.
OBJECTIVE: To determine the feasibility and reliability of muscle flaps as
a sole means of closure of severe esophageal defects. DESIGN: Retrospective
case series of patients with esophageal defects closed with muscle flaps.
Mean follow-up was 6 years. SETTING: A university hospital and a tertiary
care, university-affiliated, private hospital. PATIENTS: Fourteen patients
with esophageal defects that could not be closed by standard suture
techniques or failed to close with observation alone. MAIN OUTCOME
MEASURES: Survival, continued esophageal leakage, restoration of esophageal
continuity, and long-term esophageal function. RESULTS: There was one
operative death and one delayed death, both unrelated to the esophageal
injury. There were five early leaks that healed promptly. Esophageal
continuity was restored in all patients. Long-term esophageal function has
been excellent. CONCLUSIONS: The use of primary muscle repair for
esophageal defects not amenable to standard closure techniques provides an
excellent means of closing esophageal wounds and restoring esophageal
continuity. This option appears to be preferable to other more destructive
options in managing this serious problem.
