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Pharyngotracheal fistula closure using the internal mammary artery perforator island flap
Author(s) -
Mirghani Haïtham,
Leymarie Nicolas,
Amen Furrat,
Qassemyar Quentin,
Leclère Franck Marie,
Kolb Frederic
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24372
Subject(s) - medicine , surgery , mammary artery , laryngectomy , fistula , medical record , stoma (medicine) , retrospective cohort study , head and neck , leak , larynx , artery , environmental engineering , engineering
Objectives/Hypothesis Salvage laryngectomy following organ preservation therapy is a frequent condition that exposes patients to pharyngocutaneous and pharyngotracheal fistulas. Definitive treatment frequently requires well vascularized tissue harvested from the chest. To limit tracheostoma obstruction, a thin and pliable flap is preferable. The internal mammary artery perforator (IMAP) island flap fulfills these criteria, but it is not well known and is not commonly used by head and neck surgeons. In this article, based on our experience, we describe our surgical technique and the strengths and weaknesses of this flap. Study Design Retrospective cohort study and systematic review of the literature. Methods An IMAP flap was performed on 12 patients to repair postoperative fistulas, located in the lower neck close to the tracheal stoma or involving the posterior tracheal wall, from March 2009 to December 2012. The medical records of each of patient were retrospectively analyzed. Results A breach of the pleura occurred in one patient. It was diagnosed and treated perioperatively. One patient had a total flap necrosis and required a reoperation. The postoperative course was uneventful in 11 patients (92%). All donor sites were closed primarily without any wound‐healing problems. Conclusions The IMAP flap is reliable. Its advantages make it a convenient flap to repair peritracheostomal defects and fistulas. The harvesting technique is not very demanding but requires training. Level of Evidence 4. Laryngoscope , 124:1106–1111, 2014