Retrosternal gastric conduit necrosis after esophageal bypass is a rare but serious complication requiring complex salvage reconstruction. Here, we report a case successfully treated with free jejunal transfer combined with a pectoralis major muscle flap.
A 68-year-old man with unresectable advanced thoracic esophageal cancer underwent esophageal bypass using a Y-shaped gastric conduit via the retrosternal route. Postoperatively, he developed pneumonia, cervical infection, and anastomotic leakage, followed by partial necrosis of the gastric conduit extending to the posterior surface of the sternum. Salvage surgery was performed on postoperative day 25. Limited hemisternectomy resulted in insufficient operative exposure and intraoperative injury to the gastric conduit during sternal division, necessitating reconstruction using a free jejunal graft. Microvascular anastomoses were performed to the transverse cervical artery and the external jugular vein. A pectoralis major muscle flap was used to cover the anastomotic site and prevent local complications.
This case highlights the importance of adequate surgical exposure during sternal resection and demonstrates the usefulness of the pectoralis major muscle flap in high-risk salvage esophageal reconstruction.
