Treatment of tracheocutaneous fistulae in children.

Tracheocutaneous fistula is a frequent sequel of long-term tracheotomy in children and adults. Persistence of the tracheotomy stoma can lead to increased morbidity and mortality, especially in patients with limited pulmonary reserve. Recommendations for treatment have included both primary closure as well as excision of the fistulous tract with healing by secondary intention. Operative management and outcome of tracheocutaneous fistula performed at The Hospital For Sick Children between January 1978 and January 1988 was reviewed retrospectively. Complications of primary closure included pneumothorax, pneumomediastinum, and poor wound healing, often leading to significant patient morbidity. Excision of the fistulous tract and temporary replacement of the tracheotomy tube with secondary wound healing resulted in no complications and successful closure in all cases. In our experience, tracheocutaneous fistula in the pediatric population are best managed in this way.