Failed voice restoration: closure of the tracheo-oesophageal fistula.

Tracheo-oesophageal fistula and voice prosthesis have revolutionised voice rehabilitation, but are not without their complications. The most significant problem is widening of the tracheo-oesophageal fistula relative to the voice prosthesis and subsequent leaking. Three-layer surgical closure is a means of permanently closing a problematic fistula. Use of an interposition in situ muscle graft as a second layer provides an adequate, well vascularised barrier to prevent fistula reformation. Our technique provides a safe, effective method of closing a problematic tracheo-oesophageal fistula. We report a five case series in which 100% of patients acquired satisfactory closure of their fistulae and resolution of their symptoms.