Platysma Myocutaneous Flap for Patch Stricturoplasty in Relieving Short and Benign Cervical Esophageal Stricture Yi-Dan Lin, MD, Yao-Guang Jiang, MD,

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Platysma Myocutaneous Flap for Patch Stricturoplasty in Relieving Short and Benign Cervical Esophageal Stricture Yi-Dan Lin, MD, Yao-Guang Jiang, MD, Ru-Wen Wang, MD, Tai-Qian Gong, MD, Jing-Hai Zhou, MD The Annals of Thoracic Surgery Volume 81, Issue 3, Pages 1090-1094 (March 2006) DOI: 10.1016/j.athoracsur.2005.09.005 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Photographs of a patch stricturoplasty using the platysma myocutaneous flap (PMCF) in the treatment of a cervical gastroesophageal anastomotic stenosis. (A) Preoperative schematic marker indicating incision and the PMCF. (1) The incision would be made along the anterior border of the sternocleidomastoid muscle or by reopening a previous cervical incision, and in doing so the anterior margin of the PMCF would form concomitantly. (2) The superior, (3) the inferior, and (4) the posterior margins of the rectangular shaped the PMCF overlying the inferior aspect of the platysma. (B) The gastroesophageal anastomotic stenosis was opened longitudinally through the stenosis and extended in about 1.0 cm both proximately into (1) the normal-caliber esophageal lumen and distally into (2) the normal-caliber gastric lumen. (3) The cutting edges of the elliptical defect, (4) the anterior margin of the PMCF, and (5) the thyroid gland. (C) The making of a PMCF. The skin of the PMCF was designed in a 6 ∼ 7 cm × 4 ∼ 5 cm rectangular shape, slightly larger in size than that of the elliptical defect, overlying the inferior aspect of the platysma. Completely cutting off the full-thickness of the skin and the whole layer of the underlying platysma on each site of the three margins, (1) the anterior, (2) the superior, and (3) the inferior PMCF margins each contained both a skin part and a platysma part. However, (4) the posterior incise margin was constructed only by the skin part because the dissection and dissociation there were mandatory to perform just in the subcutaneous layer for avoiding any damage to the competence of (5) the underlying platysma pedicle. (6) The left sternocleidomastoid muscle. (D) The anterior PMCF margin was anchored to the left incise edge of the elliptical defect using full-layered interrupted sutures with (1) No. 4 nonabsorbable silk lines. (2) The right incisal edge of the elliptical defect, (3) the gastric lumen, and (4) the gastric tube. (E) The PMCF was rotated forward so that (1) the skin paddle was facing into the esophageal and (2) the gastric lumen. The PMCF was sewn in place to (3) the incisal edges of the elliptical defect using full-layered interrupted sutures with (4) No. 4 nonabsorbable silk lines. The Annals of Thoracic Surgery 2006 81, 1090-1094DOI: (10.1016/j.athoracsur.2005.09.005) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preoperative and postoperative photographs of barium meal study on a patient suffering a scarred constriction after caustic cervical esophageal injury. Left: an intensive caustic stricture was identified in the cervical esophagus. Middle: the patch stricturoplasty was performed primarily applying the PMCF in relieving the short and benign cervical esophageal stricture. However, from the first postoperative month a mild bulge was found to gradually form in the reconstructed gullet (arrow). Nevertheless the bolus transfer was not affected. Right: a smooth passage of barium meal through the reconstructed gullet 4 years after the operation (arrow). The Annals of Thoracic Surgery 2006 81, 1090-1094DOI: (10.1016/j.athoracsur.2005.09.005) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions