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Seventy-four-year-old patient who had undergone laryngectomy, neck dissection and radiotherapy for laryngeal cancer. He was treated for an extrathoracic TEF (A) using a split anterolateral thigh (ALT) flap with two skin islands (B) that was anastomosed to the internal mammary vessels (C). One skin island was used for fistula closure (D,E) and the other to cover the skin defect cranial from a permanent tracheostomy (F,G); long term result after 6 months.
