Posterior tibial artery flap for reconstruction of the esophagus.

Three patients presented who needed reconstruction of the entire esophagus. Because the stomach and colon were not available in these patients, a posterior tibial artery flap was employed for reconstruction. In the first stage, the long and wide skin flap was elaborated into a skin tube to create the major portion of esophagus in the subcutaneous tunnel. In the second stage, the lower end of the skin tube was joined to the jejunum in Roux-en-Y fashion. This method resulted in smooth passage of food and early rehabilitation for these patients. However, this procedure has the disadvantage of a scar over the leg. In addition, this procedure has the following limitations: (1) a well-vascularized leg is necessary, and (2) a hairless leg is necessary. Although this would not be a procedure of first choice, it remains a worthwhile backup procedure in esophageal reconstruction.