Reconstruction of cervical and upper thoracic esophagus with a free posterior tibial artery perforator flap A case report

Introduction: Esophageal window defect in patients with esophageal resection could be challenging to repair. In this case report, a free posterior tibial artery perforator flap (FPTAPF) was used for semi-circumference patch esophagoplasty. Patient concerns: For this 47-year-old male patient with recurrent laryngeal nerve schwannoma invading cervical and upper thoracic esophagus, cervical and upper thoracic esophageal reconstruction following tumor resection was needed Diagnosis: Pathologic result demonstrated recurrent laryngeal nerve schwannoma. Ultrasound examination detected a tumor (7 cm x 6 cm x 3 cm) located behind the right thyroid lobe, and contrast-enhanced computed tomography scan revealed that tumor was located between the cervical esophagus and trachea, and compressed these structures. Interventions: The tumor had a size of 7 cm x 6 cm x 3 cm, and the semi-circumference defect of the cervical and upper thoracic esophagus was about 7 cm in length after complete tumor resection. A 7 cm x 4 cm FPTAPF was designed and harvested for esophageal reconstruction. Outcomes: The posterior tibial flap survived well and satisfactory recovery of esophageal function was obtained with no significant complications. No local tumor relapse was indicated by computed tomography during the 2-year postoperative follow-up. Conclusion: This case highlights the stable performance of FPTAPF when used for the reconstruction of large esophageal window defect.