Management of tracheocutaneous fistula.

Management of large tracheocutaneous fistulas is not well described in the otolaryngology literature. Some authors have focused on the excision of the fistula tract with or without the use of a strap muscle or sternocleidomastoid flap. Others have proposed staged closures over a period of months to allow secondary healing to occur in order to avoid complications of dehiscence, pneumomediastinum, and infection. We describe a simple technique that utilizes the fistula tract to facilitate closure of a large tracheocutaneous fistula. By using this technique, the surgeon avoids the complications generally associated with the closure of such defects and also the morbidity of waiting for secondary closure to occur.