# Use of Endo GIA™ With Tri-staple™ and Local Muscle Flaps in Neopharyngeal Reconstruction Following Salvage Total Laryngectomy

## TL;DR

A new surgical technique using a stapler and local muscle flaps is proposed to improve outcomes in complex throat reconstructions after laryngectomy.

## Contribution

A novel neopharyngeal reconstruction method using Endo GIA™ with Tri-Staple™ and local muscle flaps is introduced for salvage total laryngectomy.

## Key findings

- The technique provides secure closure and reduces operative time in high-risk patients.
- Local muscle reinforcement enhances vascularity and lowers fistula risk in irradiated patients.
- The approach avoids donor site morbidity and offers a practical alternative to traditional flap methods.

## Abstract

Salvage total laryngectomy (STLx) is associated with higher complication rates than primary procedures, particularly in patients with a history of radiation therapy, where delayed wound healing and pharyngocutaneous fistula remain major challenges. Commonly recommended approaches, such as pedicled or free tissue flaps, may reduce complications but often prolong operative time, enlarge the surgical field, and add morbidity. In this technical report, we describe a neopharyngeal reconstruction technique using Endo GIA™ with Tri-Staple™ Technology (Covidien, North Haven, Connecticut), reinforced with local muscle flaps, as an alternative in STLx. After laryngeal mobilization, the neopharynx was closed with a 60-mm stapler, with an additional cartridge when necessary, and reinforced with submucosal and cricopharyngeal sutures. Bilateral sternocleidomastoid sternal heads and strap muscles were rotated over the staple line to provide vascularized support. This approach offered secure closure, shortened operative time, minimized reconstructive complexity, and avoided donor site morbidity, while the local muscle reinforcement enhanced vascularity and reduced the risk of fistula formation in high-risk irradiated patients. We believe that stapler-assisted neopharyngeal closure combined with local muscle flaps represents a practical and effective strategy for STLx, with the potential to lower complication rates, facilitate recovery, and serve as a valuable alternative to more extensive reconstructive procedures.