Flap Reconstruction for Esophageal Perforation Complicating Anterior Cervical Spinal Fusion: An 18-year Experience

BACKGROUND: Esophageal injury following anterior cervical discectomy and fusion (ACDF) poses a significant reconstructive challenge. Buttressing flap repairs have proven beneficial; however, there remains a paucity of evidence to guide optimal flap selection. METHODS: A retrospective chart review was performed for patients who presented to the senior author with esophageal perforations after ACDF from 1995 until present. Demographic, clinical, and postoperative details were collected. Outcomes of omental flap reconstructions were compared against other flap reconstructions. RESULTS: A total of 13 flap reconstructions were performed in 11 patients with the following distribution: 7 free omental, 1 anterolateral thigh, 1 osteomuscular fibula, 2 radial forearm, and 2 pedicled pectoralis flaps. Patients receiving omental flap reconstructions demonstrated a significantly faster resolution of leak on contrast swallow imaging and earlier return to oral feeding compared with all other flap reconstructions (22.5 versus 268 days, respectively; P < 0.05). This relationship remained evident even when calculations excluded an outlying patient from the nonomental cohort (22.5 versus 111 days, respectively; P < 0.05). Length of hospital stay, complications, and success rates were also more favorable in the omental cohort but failed to reach statistical significance. CONCLUSIONS: Esophageal perforation after ACDF is an uncommon but devastating complication. The use of free omentum flap reconstruction is associated with a more rapid functional recovery and may prove beneficial in the management of these challenging cases.