title: Primary tracheoesophageal puncture with supraclavicular artery island flap after total laryngectomy or laryngopharyngectomy.
abstract: The supraclavicular artery island flap (SCAIF) is increasingly employed for laryngectomy reconstruction with excellent success. Although tracheoesophageal puncture (TEP) with intraoperative prosthesis placement is also positively reported, this is not described in patients following SCAIF. We review our experience with primary TEP with prosthesis placement and voice outcomes in patients after SCAIF reconstruction. Seven patients underwent SCAIF with primary TEP after laryngectomy from 2011 to 2013. Five underwent total laryngectomy (TL) and 2 underwent TL with partial pharyngectomy. All patients had 16 French Indwelling Blom-Singer prostheses placed intraoperatively without complications. Six patients achieved tracheoesophageal voice (median time = 1.5 months). Two patients required cricopharyngeal segment Botox injections. One patient remained aphonic. One patient developed prosthesis leakage addressed with prosthesis replacement. Our preliminary data demonstrate that similar to free tissue transfer reconstruction, primary TEP with intraoperative placement of the voice prosthesis at the time of SCAIF reconstruction is safe and effective.
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rosh K V
authors.initials: RK
authors.lastname: Sethi
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Elliott D
authors.initials: ED
authors.lastname: Kozin
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Lam
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Emerick
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Daniel_Deschler@meei.harvard.edu.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002968:Clavicle / Q000098:blood supply; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010611:Pharyngectomy / Q000379:methods; D011677:Punctures / Q000379:methods*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome
keywords: supraclavicular artery island flap; total laryngectomy; tracheoesophageal puncture; voice prosthesis; voice restoration