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Wookey flap procedure allows cancer survivor with melted food pipe to eat again

Lenox Hill Hospital doctor performs 2-step procedure to reconstruct food pipe that had melted down

New York, NY —

It’s been a long and unexpected journey for 70-year-old Vaughn Isaacs, who survived two bouts with cancer and a serious complication from radiation treatment that literally melted his food pipe and forced him to rely on a feeding tube. But there is finally an end in sight for the Syracuse native and member of the Oneida Indian Nation. Thanks to a unique procedure performed by Gady Har-El, MD, chief of head & neck surgery at Lenox Hill Hospital, Mr. Isaacs now has a functioning food pipe that will allow him to eat and drink on his own for the first time in three years.

After more than 60 radiation treatments, Mr. Isaacs developed a pharyngocutaneous fistula (PCF) between his food pipe and neck skin. A fistula is an abnormal passageway between two parts of the body that are not typically connected. 

Dr. Har-El sought to close the worsening fistula by implementing his own modification of the standard Wookey flap surgery, a procedure that involves taking flaps of skin and muscle from the chest to reconstruct the food pipe. At his most recent follow-up exam three months post-surgery, Mr. Isaacs was able to successfully drink from a cup and was given the news that he had been long waiting for – he could begin eating solid, albeit soft, foods through his mouth again.

A complication from radiation

After being diagnosed with laryngeal cancer 20 years ago, Mr. Isaacs, better known by friends and family as “Chip,” underwent radiation treatment and a total laryngectomy, a complete removal of the voice box. He would remain cancer-free for more than a decade.

In that time, the silversmith returned to his work and continued to grow his business crafting and selling ornate jewelry, big wooden sculptures and intricately carved knives – some of which have won awards at state fairs and even garnered interest from the Smithsonian Institute, Mr. Isaacs said. 

He already knew sign language, but was determined to speak again. He taught himself how to use an electrolarynx, which transmits vibrations through his throat, allowing his mouth to produce speech. Because the sound it generates can be hard to understand, Mr. Isaacs relies on his best friend and caretaker, Kathy Salmon, to act as his interpreter.

Dr. Har-El examines Mr. Isaacs at a follow-up visit after Wookey flap procedure is completed
Dr. Har-El examines Mr. Isaacs at his follow-up visit.

Unfortunately, the cancer returned in 2016.

While undergoing radiation and chemotherapy, Mr. Isaacs discovered liquid leaking from a small opening in his neck. Doctors in Syracuse diagnosed him with the fistula and realized that, though the radiation treatment got rid of the cancer, the exposure damaged the surrounding soft tissue to the point where he had a melted food pipe that was unable to heal. 

With every radiation treatment he received, the hole only got bigger.

Surgeons in upstate New York made multiple attempts to close the fistula, but each measure failed and Mr. Isaacs had no choice but to get a feeding tube inserted directly into his stomach. 

The retired Army Ranger, who served two tours in the Vietnam War, recalls one of these failures by using his fingers to motion blood spewing out of his neck. Miss Salmon, who is always by his side, also remembers vividly the exact moment the fistula re-opened.

“All hell broke loose,” Miss Salmon recounted. “That’s not something I’d want to go through again.”
Mr. Isaacs was running out of options, that is, until last September when he got a referral to see Dr. Har-El, an internationally renowned head and neck surgeon.

Re-working the Wookey flap

When it came time to determine the best option for reconstructing Mr. Isaacs’ food pipe, Dr. Har-El turned to the Wookey flap. Widely known for his clinical and academic achievements, Dr. Har-El modified the original procedure from 1942 to include his own invention, the Har-El Pharyngeal Bypass Tube.

quotation mark Changing people’s lives is what we do here at the Cancer Institute at Lenox Hill, and that’s what we’ll continue to do.
Gady Har-El, MD

In the first stage, Dr. Har-El worked to bring the tissues from around the fistula to create the first layer of the pipe. The trick was not to close it, but rather to put it back in its original place to acclimate the tissue to a lower blood supply. A few weeks later, he elevated the tissue again, this time, ready to close it. 

Before connecting the tissue back together to form the passage, Dr. Har-El integrated his patented bypass tube, which acts as a stent and prevents the exposure of saliva to the healing area by diverting it directly to the stomach. Another feature of the tube is the unique funnel shape, which is designed to anchor at the base of the tongue. It also serves as a scaffold to hold the reconstruction in place. The last step involved grafting muscle and skin from Mr. Isaacs’ chest to cover the wound and form the outer layer.

 “With significant advances in surgical and radiation treatment of head and neck cancers, fistulas are less common, but I still see quite a number of referrals with this devastating condition,” noted Dr. Har-El. “We developed this special reconstructive protocol that builds on the original principles, but with some innovative modifications.”

From left: Dr. Har-El, Kathy Salmon, and patient Vaughn Isaacs after he was given the go ahead to begin eating solids again.

Pharyngeal reconstruction gives a new outlook on life

Mr. Isaacs, now a well-known member of his reservation, is no stranger to overcoming tough times. He was 11 years old when his mother passed away, which left him bouncing between different homes.

“No one really wanted him,” Miss Salmon said.

He learned to fend for himself and eventually joined the military. In Vietnam, he served in an elite five-man force then known as Long Range Recon Patrol – now known as Army Rangers. 

Not being able to eat normally has been one of the hardest adjustments for Mr. Isaacs, who once seized any opportunity to smoke some ribs, catch freshwater salmon or prepare beef roast.

“It’s rough with everybody eating around you and [you] can smell the food,” he explained. 

Again, Mr. Isaacs adapted. He began puréeing the same stews and vegetable soups he used to eat, straining them and then pouring them, along with conventional feeding formula, into his feeding tube.

However, now that Mr. Isaacs’ multi-step surgery is finally behind him, he looks to the future feeling excited and grateful. He is known by friends and family as being hard to read, but when it came time to thank Dr. Har-El, he was all smiles. 

“I’m thrilled he’s able to eat normally again. A lot of tradition goes with that and a lot of tradition in his family and the Native American tribe that he belongs to,” Dr. Har-El said. "Changing people’s lives is what we do here at the Cancer Institute at Lenox Hill, and that’s what we’ll continue to do.”