title: Pharyngotracheal fistula closure using the internal mammary artery perforator island flap.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Head and Neck Surgery, Institut de Cancérologie Gustave Roussy, Villejuif, Amiens, France.
authors.forename: Haïtham
authors.initials: H
authors.lastname: Mirghani
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leymarie
authors.forename: Furrat
authors.initials: F
authors.lastname: Amen
authors.forename: Quentin
authors.initials: Q
authors.lastname: Qassemyar
authors.forename: Franck Marie
authors.initials: FM
authors.lastname: Leclère
authors.forename: Frederic
authors.initials: F
authors.lastname: Kolb
mesh_terms: D000368:Aged; D005260:Female; D005402:Fistula / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D014133:Tracheal Diseases / Q000601:surgery*; D016896:Treatment Outcome
keywords: Internal mammary artery perforator flap; pharyngocutaneous fistula reconstruction; pharyngotracheal fistula reconstruction