title: Tracheoesophageal puncture site closure with sternocleidomastoid musculocutaneous transposition flap.
abstract: BACKGROUND
  Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC) transposition flap for the closure of tracheoesophageal fistula.
  
  
  METHODS
  An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea.
  
  
  RESULTS
  This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases) and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation.
  
  
  CONCLUSIONS
  This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula.
authors.affiliation: Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Dushyant
authors.initials: D
authors.lastname: Jaiswal
authors.affiliation: Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Prabha
authors.initials: P
authors.lastname: Yadav
authors.affiliation: Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Vinay Kant
authors.initials: VK
authors.lastname: Shankhdhar
authors.affiliation: Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Rajendra Suresh
authors.initials: RS
authors.lastname: Gujjalanavar
authors.affiliation: Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Puranik
keywords: Sternocleidomastoid musculocutaneous flap; flap for Tracheoesophageal puncture site; tracheoesophageal puncture (TEP) closure