Apron tracheostome.

Stenosis of the tracheostome following total laryngectomy is not an infrequent complication, either immediately postoperatively or years later, and it poses a common problem for head and neck surgeons. The opening becomes inadequate and the patient is uncomfortable and panicky. A secondary plastic operation is necessary in order to improve the airway, or a laryngectomy tube must be worn constantly. I have developed a satisfactory technique for tailoring the tracheostome during total laryngectomy so as to minimize postoperative stenosis even in irradiated cases and allow the patient to dispense with the laryngectomy tube. It may render the posterosuperior wall of the tracheostome more suitable for a tracheoesophageal puncture tract for voice restoration after total laryngectomy. These goals are achieved by interdigitating a small skin-thick superiorly based apron flap, raised from the lower midline of the front of the neck, into a similar recipient area at the upper posterior tracheal wall after removal of an equal mucosal apron.