Novel Musculocutaneous Flap for Salvage Esophageal Reconstruction.

We present a novel surgical approach for salvage reconstruction of the esophagus in a heavily irradiated field. A tracheoesophageal fistula developed in our patient after laryngectomy and tracheoesophageal puncture for laryngeal cancer. After multiple repairs failed and life-threatening complications, we developed an innovative musculocutaneous flap with extended blood supply from the axillary vessels through a matured saphenous vein loop graft. We term this the "Bring Your Own Blood (BYOB) supply" flap. This case demonstrates the viability of this approach as a last-resort option for esophageal reconstruction in heavily irradiated tissue and highlights important anatomical considerations for patients with vascular anomalies.