title: Free microvascular transfer of the vermiform appendix for creation of a tracheo-oesophageal fistula: A new method of voice reconstruction.
abstract: BACKGROUND
  Voice rehabilitation following laryngectomy can take many forms. As its basic premise, vibrating air must be transferred to the mouth where articulation takes place and speech can be produced. It requires a source of air, a conduit for transfer, and a mechanism for prevention of regurgitation and aspiration. Creating a tracheo-oesophageal fistula and maintaining it with a vascularised appendix has been the intention of this report.
  
  
  METHODS
  Three patients with an average age of 53 years underwent the procedure of free transfer of the appendix for voice restoration during the months of September 2004 through December 2004. All patients had laryngectomies and one had total cervical oesophageal reconstruction with a pedicled pectoralis major flap. Voice evaluation, swallowing function, and presence of aspiration were evaluated.
  
  
  RESULTS
  All flaps survived without complications. The results of swallowing function were unaltered from preoperative levels. All flaps remained patent at an average follow-up period of 8 months. All three patients could produce loud voice, which was intelligible at a reasonable distance. Maximal phonation time was 4s in two patients and 5s in one patient. Voice rehabilitation using the free appendix flap can achieve a phonation time which is low and words and short phrases that are intelligible but limited so far to this level. The donor site morbidity is low and aspiration was not present. The results of this study indicate that this method may have a potential role in voice reconstruction but requires more experience and refinement of this technique.
authors.affiliation: Department of Plastic Surgery, 1, E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, E-da Hospital/I-Shou University, Kaohsiung County 824, Taiwan, ROC. ed100002@edah.org.tw
authors.forename: H-C
authors.initials: HC
authors.lastname: Chen
authors.forename: S
authors.initials: S
authors.lastname: Mardini
authors.forename: C J
authors.initials: CJ
authors.lastname: Salgado
authors.forename: O
authors.initials: O
authors.lastname: Ozkan
authors.forename: C-W
authors.initials: CW
authors.lastname: Yang
authors.forename: W H
authors.initials: WH
authors.lastname: Hou
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001065:Appendix / Q000637:transplantation*; D003679:Deglutition; D004947:Esophagus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010611:Pharyngectomy; D013065:Speech Intelligibility; D013071:Speech, Alaryngeal; D014132:Trachea / Q000601:surgery*