Complications in surgery for stomal recurrences.

Stomal recurrences are diffuse epidermoid carcinomas of the tracheostoma. There is a 8.3% incidence associated with patients having a total laryngectomy. Most can be prevented by several prophylactic measures; however, surgery may be required. The procedure advocated is mediastinal dissection and its surgical technique is outlined. Recently the use of the pectoralis myocutaneous flap has greatly diminished morbidity and mortality associated with this procedure. The complications that may be encountered with mediastinal dissection have been categorized and analyzed. The dynamic interplay of these complications is stressed. Separately, each complication is formidible, but collectively, they may be overwhelming. This entire web of complications is synergistic and at times fatal. In essence, the motto of the surgeon when operating on a patient with a stomal recurrence should be eternal vigilance.