Gut revascularization is a versatile technique which extends the reach and versatility of enteric bypass and establishment of enteric continuity. This is demonstrated in three patients.

C.M.is a fifty-two-year-old man with esophageal discontinuity related to esophageal cancer resection and stricture formation. He had an enteric angiogram which revealed that the inferior mesenteric artery was occluded, thus excluding the possibility of a colon transposition. His stomach extensively scarred in his previous surgical endeavors that a gastric pull up was also not feasible. A long roux-en-y loop was constructed of the jejunum to reach the cervical esophagus. During this procedure the distal third of the jejunal “flap” became venously congested. Through an open sternotomy the internal mammary artery and vein were delivered down and the gut was both revascularized via a mesenteric arcade. Bowel peristalsis resumed peristalsis on table and the gut pinked up. A follow-up esophagram revealed enteric continuity.

D.F. is a 66 y.o. woman in whom a gastric pull up was performed and the stomach became disvascular. It was revascularized also into the internal mammary artery and vein via a gastro-epiploic arcade with immediate salutary effect. Long-term follow-up is provided with a cine-swallow esophagram demonstrating normal patency, peristalsis, and enteric passage of the food bolus.

J.M. is a 52 y.o. woman who underwent roux-en-y jejunal reconstruction for esophageal discontinuity. Based on the institutional experience of the first 2 patients, plastic surgery consultation was obtained prior to surgey and a planned revascularization to the internal mammary vessels was undertaken.

We conclude that gut revascularization should remain in the armamentarium of plastic surgeons and should be discussed with the general and the thoracic surgeons so they are aware of this possibility.