Commentary on Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm

Tissue augmentation treatment for periprosthetic leakage in patients who have undergone a total laryngectomy: A systematic review

“…Several therapeutic algorithms for periprosthetic leaks have been proposed to date, but there is no consensus on systematic problem‐solving approach that can guide clinicians step‐by‐step in the choice and timing of the various possible treatments 6 . The most recent publication proposes 5 steps in which the possible treatment options are considered on an ascending scale of complexity or morbidity, from conservative treatments to surgical treatments, and even to closure of the TEP 43 . The tissue augmentation therapy is the third step of the algorithm, after the use of silicone rings or specific prostheses for this type of leakage (with double flanges or large flanges), and can be performed concomitantly with other conservative treatments.…”

“…Although no differences have been found between the materials used, there are aspects to be taken into account when selecting the best possible option. The use of Collagen‐Gax is limited by a risk of hypersensitivity 43 . It is derived from cowhide and requires skin testing a minimum of 28 days prior to the procedure, in addition to a theoretical risk of transmission of Creutzfeldt‐Jakob disease which has not been reported so far 42 .…”

“…6 The most recent publication proposes 5 steps in which the possible treatment options are considered on an ascending scale of complexity or morbidity, from conservative treatments to surgical treatments, and even to closure of the TEP. 43 The tissue augmentation therapy is the third step of the algorithm, after the use of silicone rings or specific prostheses for this type of leakage (with double flanges or large flanges), and can be performed concomitantly with other conservative treatments.…”

“…The use of Collagen-Gax is limited by a risk of hypersensitivity. 43 It is derived from cowhide and requires skin testing a minimum of 28 days prior to the procedure, in addition to a theoretical risk of transmission of Creutzfeldt-Jakob disease which has not been reported so far. 42 In contrast, with Cymetra, there is no such risk of hypersensitivity.…”

Response to “Commentary on Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm”

“…We thank Dr Miguel Mayo‐Yáñez and colleagues for their interest and insightful comments regarding our article 1 …”