Surgical Treatment of Squamous Carcinoma in an Antethoracic Skin Tube Used for Esophageal Replacement Matthew P. Fox, MD, Douglas J. Mathisen, MD The.

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Surgical Treatment of Squamous Carcinoma in an Antethoracic Skin Tube Used for Esophageal Replacement Matthew P. Fox, MD, Douglas J. Mathisen, MD The Annals of Thoracic Surgery Volume 103, Issue 4, Pages e361-e363 (April 2017) DOI: 10.1016/j.athoracsur.2016.08.112 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Coronal and sagittal artistic representation of the patient’s anatomy at presentation. The native esophagus is seen joining the original skin tube near the thoracic outlet. The skin tube anastomoses with a subcutaneous jejunal interposition anterior to the sternum, which is then attached to the stomach distally. (The authors acknowledge Nicole Schulman for providing the illustrations for Fig 1.) The Annals of Thoracic Surgery 2017 103, e361-e363DOI: (10.1016/j.athoracsur.2016.08.112) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Preoperative barium swallow result showing large verrucous masses within the skin tube. The normal jejunal roux limb can be seen inferiorly. (B) Endoscopic view of the verrucous mass at the esophageal cutaneous tube anastomosis. The Annals of Thoracic Surgery 2017 103, e361-e363DOI: (10.1016/j.athoracsur.2016.08.112) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) External view of the patient’s original cutaneous tube with the verrucous mass eroding through it. (B) Construction of the new conduit from a myocutaneous flap based on the pectoralis major. The flap was tubularized and brought into the defect subcutaneously. The tube was anastomosed to the native esophagus proximally and the old jejunal interposition distally. The Annals of Thoracic Surgery 2017 103, e361-e363DOI: (10.1016/j.athoracsur.2016.08.112) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions