Role of vascularized pedicled sternomastoid muscle flap in esophageal anastomosis: an experimental simulator of congenital esophageal atresia

This study was done at Al-Azhar University Hospitals in the period from April 1996 to July 2001. A total of 30 male new Zealand rabbits 4-6 months old weighting about 2.5 Kg were the materials of this work. In this work, 3 cm segment was resected from the cervical oesophagus and the oesophagus was anastomosed to create some sort of tension similar to that is present in congenital oesophageal atresia. Pedicled sternomoistoid muscle flap was used to reinforce the anastomsis in 15 rabbit [group B]. while in the other 15 rabbits [group A] no flaps were used, Five rabbits in-group [A] and one in-group [B] developed leakage and died in the first 2 weeks postoperatively. Three rabbits from each group were sacrificed 3 weeks postoperatively and the remaining alive rabbits are 11 in-group [B] and 7 in-group [A], were sacrificed 8 weeks postoperatively. All rabbits underwent clinical examination gastrograffin swallow, postmortem macroscopical examination and histopathological study using 4 types of dyes. The aim was to study the effect of muscle flap on the incidence of leakage and stricture and the mechanism of its action. The results of the study revealed that, the muscle flaps decreases remarkably the incidence of leakage, gives an extra blood supply to the anastomotic area and decreases the fibrosis in the anastomolic area, The mucosa was healed by regeneration and not by fibrous tissue excluding its role in incidence of stricture, The muscle flap itself was gradually infiltrated by increasing fibrous tissue by time