Microvascular free tissue transfer repair of pharyngoesophageal perforation following anterior cervical discectomy and fusion

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BACKGROUND: There are no current best practice guidelines for management of pharyngoesophageal perforation (PEP), a rare complication of anterior cervical discectomy and fusion (ACDF). We describe our institution's experience with free flap reconstruction of PEP after ACDF. METHODS: Retrospective review of patients who underwent free flap reconstruction of PEP after ACDF. RESULTS: Thirteen patients underwent 13 microvascular free tissue transfers. There was 1 partial flap failure and no complete flap losses. One patient (7.7 %) had a persistent salivary leak following PEP repair. Ten (77 %) patients were able to resume oral intake. Five (38 %) developed esophageal diverticula and 2 (15.4 %) developed esophageal stenosis an average of 7.4 months after repair. CONCLUSIONS: PEP after ACDF poses a unique reconstructive challenge. While majority of these patients can successfully achieve oral diet following microvascular repair, clinically significant esophageal diverticula and stenoses may require long-term follow-up and management.

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