title: Closure of tracheoesophageal fistula with prefabricated revascularized bilaminar radial forearm free flap.
abstract: BACKGROUND
  Tracheoesophageal fistula (TEF) is a rare but serious complication associated with high mortality rates. Traditional management of TEF includes primary closure with or without interposition of regional tissue flaps but is associated with a significant recurrence risk, especially in case of larger fistulas. Application of microvascular free flap reconstruction is an emerging alternative in the surgical management of large TEFs, but may be limited by issues of flap bulkiness and requirement for neoepithelialization across the large inner flap surface.
  
  
  RESULTS
  Here, we report prefabrication of a bilaminar radial forearm free flap to successfully close a large recurrent TEF that occurred years after tracheoesophageal puncture-based voice rehabilitation in a laryngectomized patient.
  
  
  CONCLUSIONS
  The bilaminar radial forearm free flap may prove to be an important adjunct to the closure of large TEFs.
authors.affiliation: Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Volkert B
authors.initials: VB
authors.lastname: Wreesmann
authors.forename: Ludi E
authors.initials: LE
authors.lastname: Smeele
authors.forename: Frans J M
authors.initials: FJ
authors.lastname: Hilgers
authors.forename: Peter J F M
authors.initials: PJ
authors.lastname: Lohuis
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005500:Follow-Up Studies; D005542:Forearm; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011788:Quality of Life; D020127:Recovery of Function; D012008:Recurrence; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D023822:Tissue Engineering; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome