Successful repair of delayed esophageal perforation with sternocleidomastoid muscle flap after anterior cervical spinal surgery

No consensus has been available to optimize the treatment of delayed esophageal perforation. The present study was to investigate the surgical treatment for delayed esophageal perforation with sternocleidomastoid muscle (SCM) flap after anterior cervical spine surgeries. The diagnosis and treatment of 5 esophageal perforations (May 2004 to January 2013) that occurred in a delayed fashion were retrospectively reviewed. The five patients received uniform repair surgery strategy. Cervical spine was accessed through the fistula tract. The esophageal lesion was recognized by the preoperatively swallowed methylene blue. A nasogastric tube was positioned through the rupture to help locate and assess the size and shape of the lesion. The esophageal lesion was primarily closed with interrupted sutures. The ipsilateral SCM was exposed, dissected at the distal end, elevated, medially rotated, and then interposed between the cervical vertebrae and the esophagus. The caudal free end of SCM flap was sutured to contralateral longuscolli muscle. Post-operatively, supportive treatments including adequate drainage, appropriate antibiotics and cessation swallowing were provided for at least 2 weeks to facilitate healing of esophageal perforation. All esophageal perforation healed without further complications. In conclusion, surgical repair strategy including esophageal suture and a local SCM flap is capable of achieving satisfactory clinical outcome, especially in those with a large or chronic perforation.