Free microvascular transfer of the vermiform appendix for creation of a tracheo-oesophageal fistula: a new method of voice reconstruction H.-C. Chen*, S. Mardini, C.J. Salgado, O ¨ .O ¨ zkan, C.-W. Yang, W.H. Hou Department of Plastic Surgery, 1, E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, E-da Hospital/I-Shou University, Kaohsiung County 824, Taiwan, ROC Received 23 October 2005; accepted 1 January 2006 KEYWORDS Appendix; Voice; Tracheo-oesophageal fistula; Microvascular free tissue transfer; Ileo-colon; Oesophagus Summary Background: Voice rehabilitation following laryngectomy can take many forms. As its basic premise, vibrating air must be transferred to the mouth where articulation takes place and speech can be produced. It requires a source of air, a conduit for transfer, and a mechanism for prevention of regurgitation and aspiration. Creating a tracheo-oesophageal fistula and maintaining it with a vas- cularised appendix has been the intention of this report. Methods: Three patients with an average age of 53 years underwent the procedure of free transfer of the appendix for voice restoration during the months of Septem- ber 2004 through December 2004. All patients had laryngectomies and one had total cervical oesophageal reconstruction with a pedicled pectoralis major flap. Voice evaluation, swallowing function, and presence of aspiration were evaluated. Results: All flaps survived without complications. The results of swallowing function were unaltered from preoperative levels. All flaps remained patent at an average follow-up pe- riod of 8 months. All three patients could produce loud voice, which was intelligible at a rea- sonable distance. Maximal phonation time was 4 s in two patients and 5 s in one patient. Voice rehabilitation using the free appendix flap can achieve a phonation time which is low and words and short phrases that are intelligible but limited so far to this level. The donor site morbidity is low and aspiration was not present. The results of this study indicate that this method may have a potential role in voice reconstruction but requires more experience and refinement of this technique. ª 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: þ886 7 615 0011; fax: þ886 7 615 5581. E-mail addresses: ed100002@edah.org.tw (H.-C. Chen), mardinis@aol.com (S. Mardini), salgado_plastics@hotmail.com (C.J. Salgado), omozkan2000@yahoo.com (O ¨ .O ¨ zkan), ed100736@edah.org.tw (C.-W. Yang). 1748-6815/$ - see front matter ª 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2006.01.047 Journal of Plastic, Reconstructive & Aesthetic Surgery (2006) 59, 1233e1240