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

Figure 1 The pharyngeal fistula and tracheoesophageal fistula before reconstruction.

Figure 2 Split thickness skin grafting. A: The 4^th day after the split thickness skin grafting; B: The skin graft stably healed with the surrounding granulation and the cervical skin.

Figure 3 Intraoperative images of case 1. A: The flap design; B: Using the surrounding tissue including the skin to become the anterior wall of the pharynx from three directions; C: The reconstructed anterior wall of the pharynx; D: Taking a random flap from the submandibular part; E: The skin defect of the neck was reconstructed.

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.