Optimizing upper gastrointestinal reconstruction: a systematic review of muscle flap applications in esophagectomy and fistula repair.

BACKGROUND

Muscle flaps are commonly used in upper gastrointestinal surgical procedures, particularly after esophagectomy and for fistula repair. This scoping review aimed to provide a comprehensive overview of the types of muscle flaps used in esophagectomy and fistula repair, their treatment outcomes, associated postoperative complications, and long-term effectiveness.

METHODS

A systematic search was conducted for full-text articles across PubMed, Embase, Scopus, and Cochrane databases. Data on short- and long-term outcomes and complications were extracted from the studies.

RESULTS

A total of 29 studies that involved various muscle flaps, such as the pectoralis major myocutaneous flap (PMMF), sternocleidomastoid flap (SCMF), latissimus dorsi myocutaneous flap, and jejunal free flap (JFF), met the inclusion criteria. Short-term mortality was 14.89%. Long-term outcomes, such as 1- and 3-year survival rates, varied by flap type, with conventional flaps having a higher 1-year survival rate than novel flaps. The most commonly reported postoperative complications were anastomotic leaks (10.64%) and dysphagia (11.90%).

CONCLUSION

Muscle flaps, particularly PMMF, SCMF, and JFF, show promising outcomes in esophagectomy and fistula repair, with favorable survival rates and manageable complication profiles. Novel alternatives include the platysma myocutaneous flap and perforator-based intercostal artery muscle flap. The variability in postoperative complications and long-term success underscores the need for further research to optimize surgical approaches and improve patient outcomes.