Laryngoplasty with a radialis pedicle flap from the forearm: a surgical procedure for voice rehabilitation after total laryngectomy.

Tracheoesophageal puncture and insertion of a prosthetic voice device is currently the most widely surgical procedure for vocal rehabilitation after total laryngectomy. The disadvantages of voice prostheses are high initial phonation pressure, formation of granulation tissue around the voice shunt, blockage, displacement of the prosthesis, leakage of the prosthesis or the voice shunt, spontaneous occlusion when the prosthesis is accidentally removed and difficulties in replacing and cleaning the prosthesis. In an effort to avoid these problems, a substitute laryngeal tube (laryngoplasty) was fashioned from a revascularized forearm flap and connected to the trachea and pharynx in seven patients with extensive laryngohypopharyngeal carcinoma. All seven developed a voice comparable with patients fitted with a voice prosthesis. An advantage of this graft is the low phonation pressure required for voice production. Problems with aspiration have not occurred even after radiotherapy. While still in the hospital, five patients learned to speak without using their hands through the use of a tracheostomal valve. Judging by these results, this surgical procedure is a practical alternative to a voice prosthesis.