Abstract
Gastro-tracheal fistula following radical surgery for esophageal cancer is rare. Patients with serious intractable complications for which appropriate treatment was successful have been even less frequently reported. We present a case which reguired a free forearm flap to effectively treat a gastro-tracheal fistula. A 55-year-old male had an operation to remove an esophageal cancer. A gastric conduit was pulled up to the neck through the posterior mediastinum during esophageal reconstruction. At postoperative day 8, the patient developed a fever, cough, and cervical subcutaneous emphysema. CT scan and bronchoscopy revealed a gastro-tracheal fistula. Since conservative treatments were of no benefit, on postoperative day 114 a surgical repair was performed. The skin of the neck was incised ; the adhesion between the trachea and the gastric conduit was separated, then a part of a free forearm skin flap was tucked between these structures to cover the membranous defect of the trachea (microsurgical vessel anastomoses were institured). After the closure of the fistula was confirmed, the patient was allowed to start eating ; he had very few problems doing so. A free forearm skin flap could be a useful treatment option for an incidental gastro-tracheal fistula located at the thoracic inlet following esophageal cancer surgery.
