Benign tracheal-esophageal (TE) fistula after laryngectomy is a rare complication. Poor cervical tissues secondary to external beam radiation therapy make dissection of the fistula difficult, and cause residual strap muscle to be unsuitable for interposition. Here we describe an unusual case of a patient status post total laryngectomy for carcinoma of the larynx, and who was treated with adjuvant chemoradiation. The patient developed a benign giant recurrent post laryngectomy TE fistula resulting in chronic aspiration and pneumonia. We present video of the complex surgical repair.

The esophageal defect was primarily closed over a salivary bypass tube. There was a 3x5 cm membranous wall of trachea defect that could not be closed primarily. The membranous wall of the trachea was reconstructed using 1.5 mm thick AlloDerm (LifeCell Corporation, Branchburg, NJ) or processed human dermis. A left pectoralis major rotational muscle flap outside of the previously irradiated field was used for tissue interposition.

The complex TE fistula reconstruction resulted in a durable repair, allowing the patient to swallow without aspiration and dysphagia.

AlloDerm can be a valuable tool to reconstruct the membranous wall of the trachea. Only muscle outside a radiated field should be used to separate the tracheal and esophageal repairs.