1. Microsurgical reconstruction of combined tracheal and total esophageal defects 
Shadi Ghali, MD, Edward I. Chang, MD, David C. Rice, MD, Garrett L. Walsh, MD, Peirong Yu, MD 
The Journal of Thoracic and Cardiovascular Surgery 
Volume 150, Issue 5, Pages (November 2015)
DOI: /j.jtcvs
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

2. Figure 1
The second mesentery vessels are divided and revascularized in the neck. The third one is ligated, and the fourth one is left intact. The mesentery between the second and third vessels is divided to the bowel wall to unfurl the jejunum.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

3. Figure 2
A mediastinal tracheostomy was created, and the esophagus was reconstructed with a supercharged jejunal flap. The omentum and pectoralis major muscle flap were used to cover the major vessels and tracheostomy and resurface the neck.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

4. Figure 3
A tubed ALT free flap was used to reconstruct the trachea after debridement of the necrotic trachea.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

5. Figure 4
A free ALT flap was used to reconstruct the trachea and neck defect, and a supercharged jejunal flap was used to reconstruct the esophagus.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

6. Figure 5
Three-month follow-up photograph shows healed ALT flap reconstruction for the tracheal defect with a stable airway.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions