Esophageal perforation as a result of hardware migration can be a potentially fatal complication requiring extensive surgical treatment. Repair of esophageal perforation often involves a combination of primary closure and local muscle flaps. This case report presents a patient suffering from chronic esophageal perforation due to hardware migration as a complication of a prior anterior cervical discectomy and fusion. After the failure of multiple primary closures and local flap repair attempts, including pedicled sternocleidomastoid coverage, the patient underwent successful operative repair of the chronic esophageal perforation utilizing primary closure and an overlying free gracilis flap. Level of evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]