Tracheoesophageal puncture site closure with sternocleidomastoid musculocutaneous transposition flap

ABSTRACT

Introduction: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC) transposition flap for the closure of tracheoesophageal fistula. Materials and Methods: An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea. Results: This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases) and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation. Conclusion: This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula.

KEY WORDS

Sternocleidomastoid musculocutaneous flap - tracheoesophageal puncture (TEP) closure - flap for Tracheoesophageal puncture site

 

Conflicts of interest

There are no conflicts of interest.

• REFERENCES

• 1 Laccourreye O, Menard M, Crevier-Buchman L, Couloigner V, Brasnu D. In situ lifetime, causes for replacement and complications of the Provox voice prosthesis. Laryngoscope 1997; 107: 527-30
• 2 Singer MI, Blom ED. An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 1980; 89: 529-33
• 3 Blom E, Remacle M. Tracheoesophageal voice restoration problems and solutions. In: Blom ED, Singer MI, Hamaker RC. editors Tracheoesophageal Voice Restoration Following Total Laryngectomy. San Diego (CA): Singular Publishing Group; 1998: p. 73-82
• 4 Ward PH, Andrews JC, Mickel RA, Hanson Dg, Monahan GP. Complications of medical and surgical approaches to voice restoration after total laryngectomy. Head Neck Surg 1988; 10 (02) Suppl S124-8
• 5 Eerenstein SE, Grolman W, Schouwenburg PF. Downsizing of voice prosthesis diameter in patients with laryngectomy: An in vitro study. Arch Otolaryngol Head Neck Surg 2002; 128: 838-41
• 6 Andrews JC, Mickel RA, Hanson DG, Monahan GP, Ward PH. Major complications following tracheoesophageal puncture for voice rehabilitation. Laryngoscope 1987; 97: 562-7
• 7 Brasnu D, Pages JC, Laccourreye O, Jouffre V, Monfrais Pfauwadel MC, Crevier Buchman L. Results of the treatment of spontaneous widening of trachea-esophageal punctures after laryngeal implant. Ann Otolaryngol Chir Cervicofac 1994; 111: 456-60
• 8 Wetmore SJ, Johns ME, Baker SR. The Singer-Blom restoration procedure. Arch Otolaryngol 1981; 107: 674-6
• 9 Laccourreye O, Papon JF, Brasnu D, Hans C. Autogenous fat injection for the incontinent tracheoesophageal puncture site. Laryngoscope 2002; 112: 1512-4
• 10 Lorincz BB, Lichtenberger G, Bihari A, Falvai J. Therapy of periprosthetical leakage with tissue augmentation using Bioplastique around the implanted voice prosthesis. Eur Arch Otorhinolaryngol 2005; 262: 32-4
• 11 Margolin G, Masucci G, Kuylenstierna R, Björck G, Hertegård S, Karling J. Leakage around voice prosthesis in laryngectomees: Treatment with local GM-CSF. Head Neck 2001; 23: 1006-10
• 12 Singer MI, Hamaker RC, Blom ED. Revision procedure for the tracheoesophageal puncture. Laryngoscope 1989; 99: 761-3
• 13 Annyas AA, Escajadillo JR. Closure of tracheoesophageal fistulas after removal of the voice prosthesis. Laryngoscope 1984; 94: 1244-5
• 14 Hosal SA, Myers EN. How I do it: Closure of tracheoesophageal puncture site. Head Neck 2001; 23: 214-6
• 15 Judd O, Bridger M. Failed voice restoration: Closure of the tracheo-oesophageal fistula. Clin Otolaryngol 2008; 33: 261-4
• 16 McMurtrie A, Georgeu GA, Kok K, Carlin WV, Davison PM. Novel method of closing a tracheo-oesophageal fistula using a de-epithelialized deltopectoral flap. J Laryngol Otol 2005; 119: 129-31
• 17 Balasubramanian D, Iyer S, Thankappan K. Tracheoesophageal puncture site closure with single perforator-based deltopectoral flap. Head Neck 2013; 35: E60-3
• 18 Delaere PR, Delsupehe KG. Closure of persistent tracheoesophageal fistulas after removal of the voice prosthesis. Laryngoscope 1994; 104: 494-6