Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

Figure 4 Intraoperative images of case 2. A: The flap design; B: Cutting off the skin as designed to bare the subcutaneous tissue for further sewing; C: Using the two-side lower part of the surrounding tissue including the skin to become the upper wall of the tracheostoma; D: The reconstructed upper wall of the tracheostoma; E: Dissociating the side walls of the pharyngeal fistula and sewing them to become the anterior wall of the reconstructed pharynx; F: Sewing the local random flaps from three directions in a “inverted-T” fashion to close the skin defect.