Troubleshooting recalcitrant tracheoesophageal prosthesis site leak with internal mammary artery perforator flap: a case report

Background: An enlarged tracheoesophageal puncture (TEP) site is a grave complication of voice prosthesis rehabilitation. Case presentation: We report a case of periprosthetic leakage with an enlarged tracheoesophageal fistula causing aspiration, not responding to conservative management and primary closure. Internal mammary artery perforator (IMAP) flap was subsequently used in the management. The flap was successfully taken up at the recipient site with no leak post-operatively as confirmed by barium swallow, thereby preventing further aspiration. Conclusion: Though minor degrees of TEP leak usually respond to conservative management, the recalcitrant ones require active intervention which one should be aware of.