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We saved the life of a 53-year-old man who attempted suicide by swallowing sodium hydroxide solution. Two days after the episode, the thoracic esophagus, the stomach, and the spleen were removed to avoid fatal mediastinitis and peritonitis caused by total tissue necrosis and perforation of the digestive tract. Eight days after this operation, cervical esophagectomy, hyponharyngectomy, and total laryngectomy were performed, followed by reconstructive surgery both with two deltopectoral (DP) flaps and with a colic segment. Our report focuses on the superiority of the DP flap in the treatment of this case. The DP flap, which consists of the anterior deltoid portion and the pectoral portion, was first used on the left side for reconstruction of the cervical esophagus when laryngo-pharyngo-esophagectomy was performed. At the second surgery, this skin roll was extended from the neck to the midportion of the anterior chest with the basal portion of the former flap and using the DP flap on the right side. Finally, a colic segment supplied by the left colic artery was prepared and elevated subcutaneously by the ante-sternal route, and then connected with the previously reconstructed esophagus. The surface skin defect on this connecting portion was able to be covered with the remaining pedicule tissue of the DP flap on the right side. We chose the DP flap for its simplicity, taking the general condition of the patient into consideration. Although 6 months were required for reconstruction of the entire esophagus and for the patient to begin eating, 'no serious complications occurred. Not only the paddle portion of the DP flap but also its basal portion were useful for step-by-step reconstruction. The simplicity and reliability of the DP flap were confirmed in this case.

Reconstruction of the Esophagus in a Patient who Attempted Suicide by Swallowing Sodium Hydroxide Solution -Utility of DP Flap -