Pharyngotracheal fistula closure using the internal mammary artery perforator island flap

Abstract

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. Retrospective cohort study and systematic review of the literature. 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. 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. 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.