Use of a folded extended vertical lower trapezius island myocutaneous flap to repair large pharyngocutaneous fistulae developing after salvage total laryngectomy

The purpose of this study was to evaluate the outcomes of surgery involving the use of folded trapezius flaps to repair large pharyngocutaneous fistulae (PCFs) developing after salvage total laryngectomy. Folded extended vertical lower trapezius island myocutaneous flaps (TIMFs) were created to repair large PCFs that developed after salvage total laryngectomy in eight patients. The maximum fistula dimension was 4.5 x 3.0 cm and the minimum was 2.0 x 1.8 cm. The skin paddle of the extended vertical TIMF ranged from 5 cm to 9 cm in width and 10 cm to 23 cm in length. The inner lining ranged from 3 cm x 3 cm to 6 cm x 6 cm in dimension and the outer lining from 6 cm x 5 cm to 16 cm x 9 cm. The folded flaps provided both inner mucosa and outer lining. All flaps survived. No fistula recurrence or stricture developed. After 6-24 months of follow-up, six patients showed no evidence of disease, one was alive with disease, and one had died of local recurrence at 20 months. The folded flap was very reliable and is well-suited for repairing large PCFs, even early large PCFs and those featuring carotid artery rupture.