Multi-Disciplinary Surgical Approach to Esophageal Reconstruction: The Role of the Plastic Surgeon

Reconstruction of the esophagus is a highly interdisciplinary undertaking that involves a wide range of specialties in all phases of care. Esophageal reconstruction may be indicated for a number of reasons, which range from oncologic resection to traumatic injuries to congenital defects. The ultimate goals of esophageal reconstruction are to provide soft tissue coverage of the defect, restore continuity of the gastrointestinal (GI) tract, create a functional conduit, and allow for oral intake. This can be achieved through a number of different surgical techniques, which depend on the extent of the defect. For non-circumferential patch defects of the esophagus, local muscle flaps from the neck and trunk are commonly used. For shorter segmental defects, interposition small intestine free flaps or tubularized fasciocutaneous flaps from the extremities are employed. For longer segmental defects, sections of the native GI tract (such as stomach, colon, or jejunum) are recruited to reconstruct the esophagus. The most common complications of esophageal reconstruction include fistula formation, which can typically be managed conservatively, and conduit strictures, which may require serial dilation. Long-term outcomes are typically favorable, with good restoration of swallowing and speech and overall high quality of life in long-term survivors. New developments in tissue engineering involving the use of biological substitutes have also shown promise in esophageal reconstruction. These methods involve the placement of biologic matrices, autologous cells and/or growth factors to restore continuity of the esophagus. In this review, we discuss the role of plastic surgery in the reconstruction of the esophagus.