Cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery salvaged with regional and free flaps.

ABSTRACT

BACKGROUND AND PURPOSE: The object of the study was to present our own experience in the management of cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery. MATERIAL AND METHODS: The study group consists of 5 patients treated in Department of Otolaryngology Poznan University of Medical Sciences in 2009-2011. Different materials and techniques were used to repair the perforations infrahyoid flap, primary sutures supported by sternocleidomastoid muscle flap, thigh flap and forearm flap in two cases. RESULTS: Four out of 5 patients were referred to our department in a poor general condition, with infected neck fistulas, three patients after prolonged conservative treatment, and three patients after initial attempts to repair the perforation outside our institution. One-stage reconstructive surgery was successful in three cases, while in two others secondary interventions were necessary. Total hospital stay ranged in the analysed group from 23 to 191 days, hospital stay in our department from 1 to 62 days, hospital stay from the final procedure from 18 to 26 days. Swallowing function was within normal limits in all cases 12-14 days after the surgery. CONCLUSIONS: The authors' experience shows that in long-lasting and infected cervical oesophageal and hypopharyngeal perforations following anterior cervical spine surgery distant flaps should be primarily used as a source of a well-vascularized and unchanged tissue. It seems to be crucial to repair the perforations immediately after the first symptoms appear - such an approach significantly reduces total hospital stay and improves the prognosis.