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94. Remacle MJ, Declaye XJ. Gax-collagen injection to correct an enlarged tracheoesophageal fistula for a vocal prosthesis. Laryngoscope 1988; 98:1350-1352. 95. Brasnu D, Strome M, Laccourreye O, Weinstein G, Menard M. Gax-Collagen as an adjunctive measure for the incontinent myomucosal shunt. Arch Otolaryngol Head Neck Surg 1991; 117:767-768. 96. Rokade AV, Mathews J, Reddy KT. Tissue augmentation using Bioplastique as a treatment of leakage around a Provox 2 voice prosthesis. JLaryngolOtol 2003; 117:80-82. 97. Lorincz BB, Lichtenberger G, Bihari A, Falvai J. Therapy of periprosthetical leakage with tissue augmentation using Bioplastique around the implanted voice prosthesis. Eur Arch Otorhinolaryngol 2004; 262:32-34. 98. Kasbekar AV, Sherman IW. Closure of minor tracheoesophageal fistulae with calcium hydroxlapatite. Auris Nasus Larynx 2013; 40:491-492. 5.4.1.3.3 Surgical closure If the peripheral leakage is not solvable with these conservative surgical measures, surgical closure of the TEP tract and subsequent re-puncture may be necessary (see Surgery chapter 3.4.1 and 3.4.2 TEP tract closure). Seldom, the TEP tract has widened so much that tissue is needed to close the defect. For this, a Pectoralis Major muscle flap with split skin grafting or a free flap can be used.99,100 And again, this should not be done without also taking care of the co-morbidities mentioned above. 99. Lorenz KJ. The development and treatment of periprosthetic leakage after prosthetic voice restoration: a literature review and personal experience. Part II: conservative and surgical management. Eur Arch Otorhinolaryngol 2014. 100. Wreesmann VB, Smeele LE, Hilgers FJ, Lohuis PJ. Closure of tracheoesophageal fistula with prefabricated revascularized bilaminar radial forearm free flap. Head Neck 2009; 31:838-842. 79